YRL 

AOTT? 

0  

0  — , 

6  =  - 

1  ' 

0  ^  . 
3  " 


UC  SOUTHERN  REGIONAL  LIBRARY  FACILITY 


AA    000  621  710    3 
FORM  75 
(SECOND  KDITION) 


STANDARDS  OF 

PHYSICAL  EXAMINATION 


FOR  THE  USE  OF 


LOCAL  BOARDS,  DISTRICT  BOARDS,  AND  MEDICAL 
ADVISORY  BOARDS  UNDER  THE  SELECTIVE-SERVICE 

REGULATIONS 


PRESCRIBED  BY  THE  PRESIDENT  UNDER  THE  AUTHORITY  VESTED  IN  EIM 
BY  THE  TERMS  OF  THE  SELECTIVE-SERVICE  LAW 


ISSUED  THROUGH  THE 
OFFICE  OF  THE  PROVOST  MARSHAL  GENERAL 


WASHINGTON 

GOVERNMENT  PRINTING  OFFICE 

19X8 


War  Depabtment, 
Washington^  September  27,  191S. 
Under  authority  vested  in  liim  by  tlie  act  of  Congress  of  May, 
18,  1917,  and  the  public  resohitions  and  acts  amendatory  thereof, 
the  President  of  the  United  States  prescribes  the  following  Rules 
and  Regulations  (jn  this  the  second  edition  of  the  Standards  of 
Physical  Examination)  for  the  government  of  Local  Boards,  Dis- 
trict Boards,  and  Medical  Advisory  Boards,  and  directs  that  they 
be  published  for  the  government  of  all  concerned,  and  that  they 

be  strictly  observed. 

B.  Crowt^ll, 

Acting  Secretary  of  Wa7\ 
(2) 


SRLF 
YRL 


TABLE  OF  COXJENTS. 


Page. 

Important  prefatory  notice 4 

I.  Preliminary  statement  and  rules 5-8 

II.  Order  and  method  of  examination 8-9 

III.  Eyes 9-15 

IV.  Ears 15-17 

V.  Mouth,  nose,  fauces,  pharyBX,  larj-nx,  trachea  and  esophagus 17-19 

VI.  Dental  requirements 19-20 

VII.  Skin 20-21 

VIII,  Head 21-22 

IX.  Spine 22-24 

X.  Scapulie 24 

XI.  The  extremities 24-27 

XII.  Height,  weight,  and  chest  measurements 28-30 

XIII.  Abdomen 30-32 

XIV.  Neck 32-33 

XV.  Genito-urinary  organs  and  venereal  diseases 33-36 

XVI.  Mental  and  nervous  diseases 3G-40 

XVII.  Lungs  and  chest  wall 40-43 

X\'IIT.  Heart  and  blood  vessels 43-48 

XIX.  General 48 

XX.  Temporary  defects 48-49 

XXI.  Purposely  caused  physical  defects 49 

XXII.  Notes  on  malingering 49-51 

Appendix:  Important  sections  of  the  Selective  Service  Regulations — Rules  of 

ProccduTe 53-70 

(3) 


IMPORTANT  PREFATORY  NOTICE. 

This  second  edition  of  Standards  of  Physical  Examination,  P.M. 
G.  O.  Form  75,  supersedes  the  first  edition  published  June  5,  1918, 
and  the  use  of  the  latter  must  be  abandoned  at  once  and  all  copies 
destroyed  except  a  sufficient  number  to  complete  the  permanent 
reference  files  at  State  Headquarters  and  Local  and  District  Boards. 

This  edition  should  be  carefully  studied  for  observation  of 

IMPORTANT  CHANGES. 

1.  In  the  procedural  rules  (Selective  Service  Regulations,  second 
edition,  see  appendix  hereof)  a  registrant  no  longer  has  the  right 
or  privilege  of  applying  to  be  sent  to  a  Medical  Advisory  Board; 
nor  need  a  registrant,  sent  by  a  Local  Board  to  a  Medical  Advisory 
Board,  be  sent  to  or  examined  bj''  the  entire  Medical  Advisory  Board, 
but  may  be  sent  to  and  examined  by  any  member  or  members  thereof 
designated  by  the  Local  Board. 

2.  The  changes  in  the  Physical  Standards  proper  are  few,  and 
have  been  adopted  mainly  for  the  purpose  of  making  available  the 
greater  numJjer  of  registrants  having  remediable  defects  (Group 
B)  by  transferring  them  to  Group  C  for  special  or  limited  service. 
When  inducted  and  accepted  at  camps,  the  defects  may  be  corrected 
when  convenient;  meanwhile,  the  Army  will  have  the  benefit  of  the 
services  of  these  men. 

3.  Registrants  who  have  heretofore,  upon  examination,  fallen 
into  Group  B  (the  deferred  remediable  gToup)  but  who  now,  under 
the  revised  Form  75,  have  physical  defects  placing  them  in  Group 
C  (as  physically  qualified  for  special  or  limited  military  service), 
should  at  once  be  reviewed,  reexamined  if  necessarj'',  and  recorded 
in  Group  C,  subject  to  call  for  special  or  limited  military  service. 

4.  The  next  most  important  change  is  that  which  cites  certain 
variations  from  Army  physical  standards  in  the  assignment  of  in- 
ducted men  to  the  Navy  and  the  Marine  Corps. 

5.  Attention  is  called  particularly  to  the  following  sections : 
Section  4  (group  changes). 

Section  5  (Navy  and  Marine  Corps  standards). 

Section  14  (prohibiting  office  examinations  for  Local  Boards). 

Section  20,  last  paragraph   (eye  examinations  for  Navy). 

Sections  22,  43,  54,  72,  73,  74,  75,  87,  100,  101,  102  (transfers  of 
certain  disabilities  from  one  phj'sical  group  to  another). 

Section  171  (induction  of  malingerers). 

Appendix  (Selective  Service  Regulations,  second  edition,  espe- 
cially sections  128^  and  177,  with  notes,  pages  61  and  64  hereof). 

(4) 


STANDARDS   OF  PHYSICAL  EXAMINATION. 

FOR  THE  USE  OF 

LOCAL    BOARDS,    DISTRICT    BOARDS,    AND    MEDICAL    ADVISORY 
BOARDS   UNDER  THE  SELECTIVE  SERVICE  REGULATIONS. 

I.  PRELIMINARY  STATEMENT  AND  RULES. 

1.  The  purpose  of  the  Standards  of  Physical  Examination  is  to 
secure  greater  efficiency  and  uniformity  in  the  examination  of  regis- 
trants and  enlisted  men.  Medical  examiners  should  consider  the 
standards  as  a  guide  to  their  discretion ;  therefore  they  are  not  to  be 
construed  too  strictly  or  arbitrarily.  The  object  is  to  procure  men 
who  are  physically  fit,  or  who  can  be  made  so,  for  the  rigors  of  field 
service,  or  for  special  and  limited  service,  and  the  determination  of 
these  questions  is  left  to  the  judgment  and  discretion  of  the  exam- 
ining boards,  appointed  under  authority  of  the  selective-service  law, 
and  to  the  militar}^  examining  surgeons  at  mobilization  camps  and 
other  army  posts  and  stations. 

2.  As  the  physical  standards  established  by  these  regulations  apply 
to  voluntary  applicants  for  enlistment,  as  well  as  to  registrants,  un- 
der the  selective-service  act,  the  term  "  registrants,"  as  used  therein, 
may  be  considered  as  including  applicants  for  enlistment  where  such 
interpretation  is  necessary  to  a  proper  application  of  the  text.  (See 
Section  151,  S.  S.  S.) 

3.  Voluntary  applicants  for  enlistment  who  do  not  come  within  the 
standards  of  acceptance  for  general  military  service  as  applied  to 
registrants  under  the  selective-service  act  will  be  rejected  for  all 
military  service,  unless  the  defects  are  waived  by  authority  of  The 
Adjutant  General  of  the  Army. 

4.  Local  Boards  have  original  jurisdiction,  subject  to  review  on 
appeal  to  District  Boards,  and  may  accept  or  reject  registrants  for 
military  service  as  follows: 

{a)  Registrants  who  on  examination  are  found  to  present  condi- 
tions which  fall  vrithin  the  proper  standards  shall  be  unconditionally 
accepted  for  general  military  service  (Group  A). 

(5)    Registrants  who  on  examination  are  found  to  suffer  from 

remediable  defects  which  fall  within  the  proper  standards  may  be 

accepted   for  general   military  service   in  the  deferred  remediable 

group  (Group  B). 

(5) 


G-roup  B  is  restricted  to  drug  addicts,  to  those  having  deformities 
which  may  interfere  with  the  wearing  of  a  uniform,  and  to  a  few  special 
conditions  cited  in  the  text.     (See  Section  128|,  S.  S.  E.) 

(c)  Registrants  who  on  examination  are  found  to  present  defects 
which  fall  within  the  projjer  standards  may  be  accepted  for  special 
and  limited  military  service  (Group  C). 

(d)  Eegistrants  who  on  examination  are  found  to  present  defects 
which  fall  within  the  proper  standards  shall  be  unconditionally 
rejected  for  all  military  service  (Group  D). 

(See  sec  128 J,  Selective  Service  Regulations,  pp.  61-63  herein.) 

(e)  Wliere  conditions  are  temporarily  disabling,  but  tend  to  a 
spontaneous  cure,  induction  should  be  delayed. 

(/)  When  a  registrant  has  some  defect  for  which,  under  the  standards 
of  physical  examination,  he  would  he  unconditionally  rejected,  hut  which 
does  not  impair  his  health,  he  may  he  accepted  for  special  or  limited 
military  service,  provided  that  he  possesses  qualifications  which  render 
his  induction  desirable,  and  that  such  induction  is  specifically  requested 
hy  military  authorities. 

5.  Navy  standards  of  physical  requirements  conform  in  the  main 
to  those  of  the  Army  included  under  Group  A.  But  registrants  who, 
on  examination,  present  the  following  defects  shall  not  he  accepted  for 
service  in  the  Navy  or  Marine  Corps : 

Eyes:   (a)  Vision  less  than  three-quarters  of  the  normal  in  either 
eye. 

(h)   Colorblindness. 
Skin:   (a)  Parasitic  affections,  including  pediculosis,  ringworm, 
and  scabies. 

{h)  Eczema. 

(c)  Psoriasis. 
Genito-urinary  organs  and  venereal  diseases : 

(a)  Absence,  atrophy,  or  non-descent  of  both  testicles. 

(h)  Venereal  disease,  any  type  or  stage. 
Height :   Over  74  inches, 

6.  Local  Boards  need  not  make  complete  physical  examination  of 
every  registrant.  Upon  discovery  of  a  defect  requiring  uncondi- 
tional rejection  the  physician  of  the  Local  Board  need  proceed  no 
further ;  but  in  all  other  cases  there  must  be  a  complete  examination 
as  prescribed  in  section  182,  Selective  Service  Regulations  (pp.  65-66 
herein). 

7.  Medical  Advisory  Boards  have  no  power  to  determine  finally 
whether  a  registrant  shall  be  accepted  or  rejected  for  militar}'  service. 
This  power  is  placed  by  the  Selective  Service  Regulations  in  the 
Local  and  District  Boards.  The  functions  of  the  Medical  Ad- 
visory Boards  are,  as  the  name  imports,  to  examine  registrants  re- 
ferred to  them  by  the  Local  Boards  and   State  Adjutants   Gen- 


eral,  and  to  return  the  result  of  their  examinations,  inserted  at  the 
proper  phaces  in  Form  1010  P.M.G.O.,  "  Eeport  of  Physical  Exami- 
nation "  (sec.  282,  Selective  Service  Regulations,  p.  227).  The  Medi- 
cal Advisory  Boards  arc  not  required  to  make  a  complete  examination 
of  every  registrant.  At  any  point  in  the  course  of  the  examination 
when  it  is  found  that  the  registrant  is  physically  or  mentally  unfit 
within  the  standards  of  unconditional  rejection,  the  examination  need 
jDroceed  no  further.  After  a  Medical  Advisory  Board  (or  a  member 
or  members  thereof,  to  whom  a  registrant  has  been  referred),  has 
completed  the  examination  of  the  registrant,  the  chairman,  or  the 
designated  member  of  the  Advisory  Board,  shall  certify  the  result 
in  the  proper  space  on  Form  1010,  and  return  the  form  at  once  in 
triplicate  to  the  Local  Board  through  the  mail  or  by  messenger 
other  tlian  the  registrant.     (See  sec.  123,  S.  S.  R.,  p.  58,  herein.) 

8.  Medical  Advisory  Boards  are  maintained  for  the  purpose  of  re- 
examination of  registrants  concerning  whose  physical  condition  the 
physicians  of  the  Local  Boards  are  in  doubt.  Local  Boards  should 
feel  free  to  ask  the  advice  of  the  Medical  Advisory  Boards  concerning 
the  mental  and  physical  fitness  of  registrants.  There  should  be  cor- 
dial co-operation  between  the  Local  Boards  and  the  Medical  xVdvisory 
Boards.  Co-operation  ma}^  be  made  profitable  and  practical  through 
actual  consultation  and  conference  between  the  Local  Boards  and 
Medical  Advisory  Boards  when  this  is  possible.  In  many  districts 
the  members  of  the  Medical  Advisory  Boards  have  the  opportunity 
to  be  in  close  touch  with  the  Local  Boards.  In  some  large  advisory 
districts  the  opportmiity  for  frequent  consultation  and  conference 
may  be  infrequent  and  difficult.  Through  the  medical  aide  to  the 
governor,  ways  and  means  for  co-operation  may  be  found.  The 
standard  of  efficiency  of  the  personnel  of  Medical  Advisory  Boards 
should  result  in  the  rejection  of  all  registrants  referred  to  Advisory 
Boards  or  members  thereof  for  examination  who  are  physically  and 
mentally  defective  within  the  standards  of  unconditional  rejection. 
This  is  very  important  as  a  measure  of  economy  and  justice  to  the 
Government,  the  Army,  and  the  registrant. 

9.  Local  Boards  and  Medical  Advisory  Boards  should  be  especially 
careful  in  the  selection  of  registrants  who  suffer  from  defects  of 
vision;  defects  of  hearing,  and  with  chronic  discharge  from  the  ear 
or  ears;  toxic  conditions  associated  with  abnormal  conditions  of  the 
thyroid  gland;  valvular  disease  of  the  heart;  tuberculosis;  epilepsy; 
mental  disease  or  deficiency ;  and  irremediable  defects  of  the  feet.  In 
other  words,  to  make  a  good  soldier  the  registrant  must  be  able  to  see 
well;  have  comparatively  good  hearing;  his  heart  must  be  able  to 
stand  the  stress  of  physical  exertion;  he  must  be  intelligent  enough 
to  understand  and  execute  military  maneuvers,  obey  commands,  and 


protect  himself ;  and  must  be  able  to  transport  himself  by  walking  as 
the  exigencies  of  military  life  may  demand. 

10.  District  Boards  have  appellate  jurisdiction  over  all  decisions 
of  Local  Boards,  including  the  findings  of  Local  Boards  as  to 
physical  qualifications;  but  in  considering  appeals  as  to  physical 
qualifications  the  District  Board  may  not  conduct  any  new  physical 
examination  nor  receive  or  consider  any  evidence  which  was  not  con- 
sidered by  the  Local  Board.  (See  sec.  126,  Selective  Service  Eegu- 
lations,  p.  60,  herein. 

11.  The  Army  medical  officer  detailed  as  Medical  Aide  to  the  Gov- 
ernor should  be  the  instrument  of  communication  between  the  gov- 
ernor or  his  Adjutant  on  the  one  hand  and  the  Local  and  Medical 
Advisory  Boards  on  the  other  hand  in  all  matters  concerning  ques- 
tions relating  to  phj^sical  examinations.     (Sec.  29,  S.  S.  R.)   ' 

12.  Local  Boards  may  not  induct  registrants  accepted  for  general 
military  service  who  are  in  tlie  deferred  remediable  group  (Group  B)  or 
for  special  or  limited  military  service  (Group  C),  until  a  special  call  has 
been  made  by  the  Provost  Marshal  General's  Office  for  these  groups  of 
registrants. 

13.  The  final  decision  as  to  the  acceptance  or  rejection  of  inducted  men 
under  these  regulations  rests  with  the  military  authorities  at  the  mobiliza- 
tion camps  or  other  military  stations  to  which  the  registrants  are  sent 
upon  induction  into  the  military  service. 

14.  No  physical  examination,  nor  any  part  thereof,  shall  be  conducted 
at  the  private  office  of  a  medical  examiner  for  a  Local  Board. 

15.  Instructions  for  the  special  guidance  of  Local  and  Medical 
Advisory  Boards  are  printed  in  heavy  type  at  the  end  of  each  chap- 
ter and  all  specific  directions  to  Local  Boards  and  to  Medical  Ad- 
visory Boards  are  printed  in  heavy  type  in  the  text. 

16.  In  the  appendix  will  be  found  general  information  and  the  im- 
portant sections  of  the  Selective  Service  Eegulations  relating  to 
physical  examinations  and  governing  Medical  Aides  and  Local,  Dis- 
trict, and  Medical  Advisory  Boards,  which  Avill  be  found  valuable  in 
connection  with  the  Standards  of  Physical  Examination. 

XL  ORDER  AND  METHOD  OF  EXA^IINATION. 

17.  The  physical  examination  should  take  place  in  a  large,  well- 
lighted  room.  A  quiet  communicating  room  should  be  used  for  the 
examination  of  the  heart  and  lungs.  The  temperature  of  the  room 
should  be  regulated  in  cold  weather  to  prevent  the  registrant  from 
becoming  chilled.  The  registrant  should  be  questioned  about  his  past 
and  his  present  physical  condition.  His  mental  characteristics  and 
speech  should  be  observed.  Malingering  should  be  borne  in  mind 
at  all  stages  of  the  examination. 


18.  No  anesthetic  may  be  given  to  a  registrant  without  his  vohin- 
tary  consent  for  the  purposes  of  examination  or  to  aid  in  the  diag- 
nosis of  defects. 

19.  The  following  order  of  i^rocediire  in  examining  a  registrant 
should  be  pursued,  as  a  rule: 

(a)  Make  tests  of  the  vision.     (See  Chapter  III.) 
(h)  Make  tests  of  the  hearing.      (See  Chapter  lY.) 

(c)  Examine  the  scalp,  face,  mouth,  teeth,  fauces,  and  nose.  (See 
Chapters  Y-VI.) 

(d)  At  this  stage  of  the  examination  have  the  registrant  take  off 
all  of  his  clothing. 

(e)  Make  a  thorough  general  inspection  of  the  skin  of  the  entire 
body.     (See  Chapter  VII.) 

(/)  Observe  the  conformation  of  the  back,  the  chest,  the  abdomen, 
the  neck,  buttocks,  and  the  upper  and  lower  extremities.  (See  Chap- 
ters XI,  XIII,  XVI.) 

(g)  Carefully  examine  the  abdomen  for  the  bulgings  of  hernia. 
(See  Chapter  XIII.) 

(A)   Palpate  the  testicles. 

(i)  Inspect  the  genitals  and  anus  while  the  registrant  is  stooping 
forward  with  the  lower  extremities  separated.  The  registrant  should 
separate  the  buttocks  with  his  hands  to  enable  the  inspection  of  the 
anus  to  be  made.     (See  Chapter  XV.) 

(j)  Have  the  registrant  vigorously  exercise  all  of  the  joints  of  the 
upper  and  lower  extremities,  and  also  move  the  head  in  all  directions 
to  test  the  mobility  of  the  joints.     (See  Chapter  X.) 

(k)  Have  the  registrant  bend  the  body  forward,  backward,  side- 
wise,  and  rotate  the  trunk  upon  the  pelvis,  to  test  the  mobility  of 
the  spine.     (See  Chapters  VIII,  IX.)  . 

(?)  Especial  attention  should  then  be  paid  to  the  feet.  (See  Chap- 
ter XL) 

(m)  Take  the  weight,  the  height,  and  the  chest  measurements. 
(See  Chapter  XII.)  ■ 

(n)  Have  the  registrant  put  on  his  drawers,  trousers,  stockings, 
and  shoes,  then  proceed  to  examine  the  chest.  (See  Chapters  XVII, 
XVIII.) 

III.  EYES. 

20.  Vision, — To  determine  the  acuity  of  vision,  place  the  person 
under  examination  with  his  back  to  a  window  at  a  distance  of  20  feet 
from  the  test  types.  Examine  each  eye  separately,  without  glasses, 
covering  the  other  eye  with  a  card  (not  with  the  hand).  The  ap- 
plicant is  directed  to  read  the  test  types  from  the  top  of  the  chart 
down  as  far  as  he  can  see  and  his  acuity  of  vision  recorded  for  each 
eye,  with  the  distance  of  20  feet  as  the  numerator  of  a  fraction  and 

83246°— IS 2 


10 

the  size  of  the  type  of  the  lowest  line  he  can  read  correctly  as  the 
denominator.  If  he  reads  the  20-feet  type  correctly,  his  vision  is 
normal  and  recorded  20/20;  if  he  does  not  read  below  the  30-feet 
type,  the  vision  is  imperfect  and  recorded  20/30;  if  he  reads  the 
15-feet  type,  the  vision  is  unusually  acute  and  recorded  20/15,  etc. 

In  examining  for  the  Navy  or  Marine  Corps,  stand  the  registrant  15 
feet  instead  of  20  feet  from  the  chart.  If  he  is  unable  at  this  distance  to 
read  the  20-foot  type,  his  vision  is  below  the  standard  required  for  Navy 
or  Marine  service. 

21.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing conditions,  who  are  otherwise  mentally  and  physically  fit, 
shall  be  unconditionally  accepted  for  general  military  service: 

(a)   Normal  vision. 

(5)  Minimum  vision  of  20/100  in  one  eye  and  20/40  in  other  eye 
without  glasses;  or  20/100  in  each  eye  without  glasses,  if  correctable 
with  glasses  to  20/40  in  either  eye. 

(c)  Conditions  due  to  iridectomy  or  other  operation  upon  the  eye 
if  the  condition  for  which  the  operation  was  performed  has  been 
relieved  and  the  vision  is  within  or  above  the  minimum  standard 
requirements. 

(d)  Slight  nystagmus. 

(e)  Slight  conjunctivitis. 

(/)  Chronic  simple  conjunctivitis  occurring  in  regions  where  tra- 
choma is  not  prevalent,  and  if  easily  remediable. 

(g)  Slight  adhesion  of  the  lids  to  the  eyeball. 

(A)   Small  pterygium. 

(i)  Slight  injection  of  lids. 

(j)  Ptosis  which  does  not  interfere  with  vision. 

(k)  Strabismus  which  does  not  interfere  with  vision. 

(7)  Color  blindness.  (Color  blindness  should  be  indicated  on  Form 
1010.) 

22.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing defects,  Avho  are  otherwise  mentally  and  physically  fit,  may 
be  accepted  for  special  and  limited  military  service,  unless  the  degree 
of  disability  is  obviously  disqualifying. 

(a)  A  minimum  vision  of  20/200  in  one  eye  and  20/40  in  other 
(either  right  or  left)  without  glasses,  or  20/200  in  each  eye  without 
glasses  if  correctable  with  glasses  to  20/40  in  either  eye. 

(h)  Blindness  in  one  eye  not  due  to  progressive  organic  change, 
with  normal  vision  in  other  eje  without  glasses. 

(c)  Chronic  conjunctivitis  not  trachomatous. 

(d)  Inversion  of  e3'elids. 

(e)  E version  of  eyelids. 

(/)  Ptosis  interfering  with  vision. 
(g)  Trichiasis. 


11 

(h)  Epiphora. 

(^)  Chronic  blepharitis. 

(j)  Extensive  pterygium. 

(k)  Chronic  dacryocystitis. 

(I)  Blepharospasm. 

(m)  Superficial  corneal  ulcer. 

(n)  Acute  inflannnatory  diseases  of  the  eyeball. 

23.  Registrants  who  on  examination  are  found  with  the  following 
defects  shall  be  unconditionally  rejected  for  all  military  service : 

(a)  Total  blindness. 

(h)  Vision  less  than  the  minimum  requirements  for  special  and 
limited  military  service. 

(<?)  Disfiguring  cicatrices  of  eyes. 

(d)  Lagophthalmus. 

(e)  Pronounced  exopthalmus. 
(/)  Chronic  keratitis. 

(g)   Chronic  recurrent  inflammatory  diseases  of  the  globe. 
(h)  Deep  ulcer  of  cornea. 

(i)  Any  organic  disease  of  the  retina,  choroid,  or.  optic  nerve. 
(j)  Detachment  of  the  retina. 
(k)  Marked  nystagmus. 

(1)   Loss  or  disorganization  of  either  eye  wiih  less  than  normal 
vision  in  remaining  eye. 
(m).  Glaucoma. 

(n)  Diplopia  due  to  paralysis  of  the  extrinsic  ocular  muscle. 
(o)  Abnormal  conditions  of  eyes  due  to  diseases  of  the  brain. 
(p)   Malignant  tumors  of  lids  or  eyeballs. 
(q)   Trachoma. 

24.  When  the  physicians  of  the  Local  Boards  are  not  supplied  with  test 
glasses  and  there  is  no  opportunity  for  the  Local  Boards  to  secure  an 
examination  of  the  registrants'  eyes  with  test  glasses,  they  should  be 
referred  to  Medical  Advisory  Boards,  or  a  specialist  member  thereof. 

25.  Local  Boards  should  encourage  oculists  and  aurists  to  serve  as  vol- 
untary assistants  in  the  examination  of  the  eyes  and  ears  of  registrants. 

26.  Local  Boards  shall  refer  all  suspected  cases  of  trachoma  to  the 
Medical  Advisory  Board,  or  to  a  member  thereof. 

VISUAL  TESTS  FOR   THE   DETECTION   OF   MALINGERERS. 

27.  Malingerers  may  feign  inability  to  open  their  eyes,  total  loss 
of  vision  in  one  or  both  eyes,  or  impaired  vision  in  one  or  both  eyes. 
Occasional!}^  an  inflammation  in  the  eyes  will  be  produced  by  putting 
sand  or  other  irritating  substance  under  the  lids. 

28.  Malingerers  who  wish  to  evade  military  service  by  feigning 
impairment  of  vision  may  be  divided  into  two  classes,  as  follows: 

(a)  Those  who  claim  total  loss  of  vision  in  one  eye. 


12 

(h)  Those  wlio  claim  partial  loss  of  vision  in  one  or  both  e3'es. 
Either  group  may  have  a  normal  acuity  of  vision  or  may  exagr 
gerate  a  defect  actually  present. 

29.  In  testing  for  malingering  the  medical  examiner  should  bear 
in  mind  that  detection  is  more  likely  to  result  \\hen  the  man  is 
allowed  to  believe  that  his  case  is  regarded  from  the  first  as  genuine 
and  tliat  his  story  is  not  discredited.  There  is  something  indefinable 
in  the  bearing  of  the  malingerer  which  experience  alone  can  detect. 
lie  may  be  self-assertive  and  overconfident;  he  may  be  hesitating  or 
evasive.  Careful  observation  should  be  made  of  his  conduct  and 
every  movement  noted.  The  nature  of  the  man's  answer  should  be 
taken  into  account  and  considered  in  the  light  of  the  kind  of  reply 
that  is  given  when  a  genuine  refraction  case  is  being  dealt  with. 

30.  The  following  equipment  is  necessary: 

Trial  frame:  blank;  spherical  lenses,  +10,  +3,  -(-0.25,  —3,  —2, 
-1,  -0.2a. 

Two  prisms,  one  6°  and  one  10°. 

Ophthalmoscope  (electric  battery  in  handle). 

Condensing  lens. 

Loupe. 

Red  and  green  letters  on  glass;  (a)  letters  varying  in  size;  (h) 
spectacle  frame  containing  red  and  green  glasses. 

Special  test  cards,  one  a  duplicate,  Avith  letters  reversed  to  use  with 
a  mirror. 

Special  illiterate  test  cards. 

Mirror,  large  enough  to  reflect  test  card.s. 

One  stereoscope  with  special  card. 

I\etinoscope  (electric,  with  battery  in  handle). 

Ruler,  about  1{  inches  wide. 

METHODS    OF   KXA>[INAT10X.     . 

Class  A.  Total  Loss  of  Vision  tn  One  Eye. 

31.  (a)  A  6°  prism  base  downward  is  placed  before  the  admittedly 
sound  eye,  while  the  man  looks  at  a  distant  light  or  candle.  If  he 
sees  two  candles,  binocular  vision  is  proved.  The  examiner  may 
vary  the  test  by  placing  the  prism  before  the  "  blind  "'  eye,  either  base 
up  or  base  down. 

(1)  A  prism  of  10°,  with  base  outward,  is  placed  before  the 
"blind''  eye.  If  there  is  any  sight  in  this  eye,  double  vision  will  be 
produced  and  the  eye  will  be  seen  to  move  inward  to  correct  it  and 
fuse  the  two  images. 

(e)  The  allegtMl  "blind  "  eye  is  covered:  A  prism  of  10°,  with  the 
apex  up,  is  placed  before  the  "  seeing  "  eye  in  such  a  position  that  its 


13 

edge  lies  horizontally  across  the  center  of  the  pupil.  This  produces 
monocular  diplopia.  The  prism  is  then  moved  upward  so  as  to  be 
completely  in  front  of  the  good  eye  and  at  the  same  time  the  "blind '* 
eye  uncovered.  If  diplopia  is  produced  or  admitted  there  is  sight 
in  the  "  blind  "  eye. 

{d)  Test  with  colored  glasses  and  letters :  This  consists  in  directing 
the  individual  to  read  a  row  of  red  and  green  letters  through  a  red 
and  ffreen  glass.  The  red  letters  will  be  invisible  to  the  eve  that  has 
the  green  glass,  and  vice  versa,  but  if  all  the  letters  are  correctl}'  read 
irrespective  of  their  color  there  must  be  sight  in  the  "  blind  "  eye. 
The  proper  illumination  back  of  the  chart  must  be  observed. 

(e)  Test  with  trial  glasses:  A  high-plus  glass  is  placed  before  the 
good  eye  and  a  low  plus  or  minus  before  the  "  blind  "  eye.  If  the 
distant  type  is  read  the  vision  in  the  "  blind  "  eye  is  good. 

(/)  The  stereoscopic  test :  This  may  be  made  with  ordinary  stereo- 
scope, the  printed  matter  so  arranged  that  certam  portions  of  it  are 
not  present  before  one  of  the  eyes. 

{g)  The  bar  test:  Interpose  a  ruler  about  1^  inches  wide  vertically 
midwa}'  between  the  two  eyes  at  about  4  to  5  inches  distance;  direct 
the  man  to  read  from  a  printed  page  with  lines  at  least  4  inches  long. 
If  able  to  read  the  lines,  binocular  vision  exists. 

(A)  The  action  of  the  pupil  must  be  carefully  tested,  there  usually 
being  no  movement  to  light  stimulation  when  the  eye  is  blind.  If 
the  examiner  is  not  satisfied,  the  following  examination  should  be 
made : 

Oblique  examination :  A  careful  examination  of  the  cornea  should 
be  made  with  the  aid  of  a  condensing  lens  and  a  loupe. 

Ophthalmoscopic  examination :  A  searching  examination  with  the 
ophthalmoscope  should  be  made,  together  with  an  estimation  of  the 
refractive  error.    The  pupil  should  be  dilated  if  necessary. 

Class  B. — Partial  Loss  of  Vision  in  One  ok  Both  Eyes. 

« 

32.  The  most  common  manifestation  of  malingering  takes  the  form 
of  a  statement  that  one  eye  is  imperfect.  Men  pleading  this  disability 
may  be  divided  into  two  classes:  (1)  Those  who  pretend  to  have  a 
visual  defect;  (2)  those  who  are  aware  they  have  a  visual  defect  and 
exaggerate  its  effect. 

No  hard-and-fast  tests  can  be  prescribed  for  the  detection  of  these 
cases.  Much  depends  on  the  alertness  and  ingenuity  of  the  medical 
examiner. 

The  tests  with  prisms  are  not  applicable  here,  for  there  is  not  pre- 
tended blindness  in  one  eye,  but  simply  an  alleged  diminution  of 
visual  acuity. 


14 

(a)  If  a  room  30  or  40  feet  long  can  be  obtained  for  testing  vision, 
place  the  registrant  suspected  of  malingering  at  30  to  35  feet  from 
the  test  chart.  Direct  him  to  read  the  letters  and  note  the  result. 
He  should  then  be  brought  up  to  20  feet  from  the  card  and  retested. 
If  he  reads  the  same  line,  he  is  malingering. 

(5)  Mirror  tests  with  special  test  cards. 

Test  cards  are  used  which  are  identical,  one  having  letters  re- 
versed. The  registrant  is  directed  to  read  the  letters  on  the  chart 
across  the  room,  and  then  in  a  mirror  beside  it,  which  reflects  reverse 
letters  that  are  placed  over  his  head.  The  letters  seen  in  the  mirror 
are  located  double  the  distance  of  the  direct  letters  from  the  man 
being  examined.  The  malingerer  is  apt  to  read  in  the  mirror  the 
line  which  he  read  on  the  first  card,  showing  that  his  vision  is  twice 
as  good  as  he  pretends. 

In  order  to  obviate  the  use  of  test  letters  in  the  mirror  test  various 
common  objects  aj^^roximating  the  size  of  the  20/40  and  20/30 
letters  may  be  used  by  asking  a  registrant  to  differentiate  ^between  a 
dime  and  penny,  a  cigarette  and  pencil,  a  pen  and  pencil,  the  num- 
ber of  spots  on  playing  cards,  or  between  the  different  aces,  held  on 
either  side  of  his  head  and  reflected  in  the  mirror  at  20  feet  distance. 

Trial  frame  test:  Place  a  trial  frame  upon  the  man's  face  and  put 
before  the  sound  eye  a  high  convex  lens  (-fl6D),  and  before  the 
"blind"  eye  a  plane  or  weak  lens  (0.25)  which  will  not  interfere 
with  vision.  If  letters  placed  at  distance  of  20  feet  are  read,  the 
fraud  is  at  once  exposed. 

(c)  Oblique  examination  with  condensing  lens  and  loupe  to  deter- 
mine corneal  or  lenticular  opacities. 

{d)  Ophthalmoscopic  examination:  It  is  probable  that  the  malin- 
gerer will  resist  the  ophthalmoscopic  examination  b}'  frequent  wink- 
ing or  rolling  of  the  eyes.  In  this  event  it  is  best  to  caution  the  man 
that  a  report  of  his  vision  must  be  made,  and  then  to  postpone 
further  examination  until  after  the  next  few  registrants  have  been 
examined. 

(e)  Estimate  the  refractive  error  with  the  use  of  the  ophthalmo- 
scope. If  no  error  of  marked  degree  exists  and  the  media  and  fundi 
are  normal,  the  relation  between  the  alleged  vision  and  the  refractive 
condition  furnishes  an  important  clue.  If  the  error  is  about  +4  or 
—2,  the  visual  acuity  could  be  about  20/100,  but  when  the  defect  can 
not  be  accounted  for  objectively  and  the  vision  is  brought  from 
20/100  to  20/50  or  20/30  by  means  of  a  low  plus  or  minus  glass,  the 
man  is  malingering. 

(/)  Eetinoscopy:  Look  for  corneal  and  lenticular  opacities  and 
estimate  refractive  errors. 


15 

OCCUPATION. 

33.  The  man's  occupation  in  civil  life  may  have  been  such  that  it 
could  not  haA^e  been  followed  without  more  vision  than  he  claims. 

In  the  absence  of  ocular  defects,  continuous  and  persistent  blephar- 
ospasm, the  use  of  colored  glasses,  eye  shades,  or  eye  bandages  should 
be  regarded  with  suspicion. 

DIPLOPIA. 

34.  Cases  of  malingering  are  occasionally  met  with  in  which  the 
men  complain  that  they  see  double.  These  must  be  investigated  with 
the  application  of  the  ordinary  tests  as  if  they  were  genuine,  with 
every  precaution  taken  to  guard  against  a  serious  nervous  lesion 
being  overlooked. 

IV.  EARS. 

35.  Hearing. — Place  the  registrant  facing  away  from  the  assistant, 
who  is  20  feet  distant,  and  direct  him  to  repeat  promptly  the  words 
spoken  by  the  assistant.  If  the  registrant  can  not  hear  the  words 
at  20  feet,  the  assistant  should  approach  foot  by  foot,  using  the 
same  voice,  until  the  words  are  repeated  correctly.  Examine  each 
ear  separately,  closing  the  other  ear  by  pressing  the  tragus  firmly 
against  the  meatus;  the  examiner  should  face  in  the  same  direction 
as  the  registrant  and  close  one  of  his  own  ears  in  the  same  way  as 
a  control.  The  assistant  should  speak  in  a  low  conversational  voice 
(not  a  whisper),  just  plainly  audible  to  the  examiner,  and  should  use 
numerals,  names  of  places,  or  other  w^ords  or  sentences  until  the  con- 
dition of  the  applicant's  hearing  is  evident.  The  acuity  of  hearing 
should  be  expressed  in  a  fraction,  the  numerator  of  which  is  the 
distance  in  feet  at  which  the  words  are  heard  by  the  registrant  and 
the  denominator  the  distance  in  feet  at  which  the  words  are  heard 
by  the  normal  ear;  thus  20/20  indicates  normal  hearing,  10/20  par- 
tial hearing  of  a  degree  indicated  by  the  fraction.  If  an}^  doubt  as  to 
the  correctness  of  the  answer  is  given,  the  registrant  should  be  blind- 
folded and  a  watch  should  be  used,  care  being  taken  that  the  indi- 
vidual does  not  know  the  distance  from  the  ear  at  which  it  is  being 
held.  The. watch  used  should  be  one  whose  ticking  strength  has  been 
tested  by  trial  on  a  normal  ear. 

36.  Registrants  who  on  examination  present  the  following  condi- 
tions, who  are  otherwise  mentally  and  physically  fit,  shall  be  uncon- 
ditionally accepted  for  general  military  service : 

(«)   Normal  hearing. 

(5)   Hearing  in  each  ear  of  10/20  or  better. 

37.  Registrants  who  on  examination  present  the  following  defects, 
who  are  otherwise  mentally  and  physically  fit,  may  be  accepted  for 
special  and  limited  militarv  service : 


\^a)   Deafness  in  one  ear  with  normal  hearing  in  the  other  ear. 
(b)  Hearing  in  one  or  both  ears  less  than  10/20  but  more  than 

5/20. 

{c)  Perforation  of  membrana  tympani  without  discharge,  defi- 
nitely determined  by  otoscopy. 

{d)  Loss  of  one  or  both  external  ears,  if  the  registrants  have  fol- 
lowed a  useful  vocation  in  civil  life  and  the  deformity  is  not  too 
greatly  disfiguring. 

38.  Registrants  who  on  examination  present  the  following  defects 
shall  be  unconditionally  rejected  for  all  military  service: 

{a)  Hearing  in  one  or  both  ears  of  less  than  the  minimum  hearing 
required  for  special  and  limited  military  service.     (See  37  (5).) 
{h)   Chronic  purulent  otitis  media,  vvith  or  without  mastoiditis. 

39.  The  Local  Boards  shall  refer  to  the  Medical  Advisory  Boards,  or  to 
a  specialist  member  thereof,  all  registrants  who  are  found  giving  a  history 
of  chronic  discharge,  or  have  a  chronic  discharge  of  the  middle  ear  or 
ears,  or  whose  hearing  is  in  doubt. 

TESTS  FOR  MALINGERING  IN   HEARING. 

40.  Individuals  who  are  malingerers  in  regard  to  hearing  usually 
claim  magnifications  of  slight  imperfections  on  one  side  with  a  com- 
plaint of  past  trouble.  Exaggeration  of  defects  in  hearing  extends 
usually  to  declarations  of  total  deafness  on  one  side. 

41.  The  following  directions  should  be  observed  in  examining 
suspected  malingerers : 

{a)  In  making  these  examinations  the  observer  should  have  a 
skilled  assistant  and  all  communications  between  them  should  be  in 
a  low  whispered  voice. 

{!))  The  assistant  should  stand  at  the  back  of  the  patient  and 
should  at  the  direction  of  the  examiner  obstruct  the  ears  of  the  sus- 
pect as  directed,  by  pressing  the  tragus  firmly  into  the  auditory 
meatus. 

{c)  The  suspected  malingerer  should  be  placed  in  the  center  of  the 
room,  free  from  all  obstructions.  His  eyes  should  be  securely  and 
completely  blindfolded. 

{d)  An  accurate  notation  should  be  made  of  which  ear  is  deaf  as 
claimed  by  the  registrant.  Then  a  critical  examination  of  the  auditory 
canal,  membrana  tympani,  and  for  the  patulency  of  the  Eustachian 
tubes  should  follow. 

(e)  Then  an  accurate  test  of  the  normal  ear  should  be  made.  Care 
should  be  exercised  not  to  allow  the  suspect  to  hear  figures  or  other 
signs  as  to  the  result  of  examination. 

(/)  If  the  suspect  gives  markedly  conflicting  statements  when  the 
normal  ear  is  tightly  plugged  as  to  the  distance  at  which  he  hears 
the  voice  or  accumeter,  it  is  fair  to  assume  he  is  a  malingerer. 


17 

(g)  The  simplest  and  most  available  test  for  malingering  is  the 
use  of  an  ordinary  binaural  stethoscope.  One  earpiece,  the  one  to  be 
applied  to  the  normal  ear,  is  packed  tightly  with  a  wad  of  absorbent 
cotton,  and  the  earpieces  are  placed  in  the  suspect's  ears.  The  exam- 
iner speaks  in  a  soft  tone  or  counts  into  the  bell-shaped  chest  portion 
of  the  stethoscope,  aild  the  suspect  is  told  to  repeat  what  he  hears. 
The  tubes  are  removed  from  the  ears,  and  the  assistant  is  told  to  stop 
the  normal  ear.  The  same  words  or  numerals  are  again  repeated. 
The  suspect  will  now  claim  failure  to  hear  the  words  or  numerals 
which  he  had  previously  heard  through  the  tube  with  the  ear  stated 
to  be  deaf. 

(h)  Erhard's  test  is  another  simple  method  for  malingerers  which 
requires  no  special  apparatus.  If  the  external  auditory  canal  of  a 
normal  ear  is  tightly  packed  with  absorbent  cotton,  it  will  still  con- 
duct sound  waves  to  a  limited  degree;  a  loud-ticking  watch  eVen 
under  these  circumstances  being  heard  about  1  or  2  meters.  The 
suspect  has  his  ear  which  is  stated  to  be  deaf  stopped,  and  then  the 
test  is  made  with  the  hearing  of  the  normal  ear,  the  suspect  being 
told  to  count  the  ticks  of  the  watch.  The  suspect's  normal  hearing 
ear  is  then  stopped  and  the  testing  is  made  with  the  supposed  deaf 
car.  Under  this  test,  if  he  claims  failure  to  hear  the  watch  under  1 
meter,  he  is  malingering. 

(i)  The  Chiman-Moos  test  is  made  with  the  C2  tuning  fork.  The 
vibrating  tuning  fork  is  held  at  equal  distances  from  each  ear.  The 
suspect  may  claim  that  he  hears  it  better  in  the  normal  ear.  The  vi- 
brating tuning  fork  is  then,  placed  on  the  vertex  of  the  skull.  The 
suspect  hearing  it  equally  well  in  both  ears  will  at  first  hesitate  and 
then  state  he  hears  it  better  in  the  normal  ear.  In  diseases  of  the  con- 
ducting apparatus  he  should  hear  it  better  in  the  diseased  ear.  If, 
now  the  external  meatus  of  the  normal,  ear  is  tightly  closed  and  the 
vibrating  tuning  fork  is  placed  upon  the  vertext  of  the  skull,  the  in- 
dividual with  the  diseased  ear  will  state  he  hears  it  better  in  tho 
normal  closed  ear ;  or,  it  may  be  impossible  for  him  to  decide  in  which 
ear  he  perceives  the  tone  better.  The  suspect,  with  the  normal  ear 
tightly  obstructed,  will  state  that  he  does  not  perceive  the  sound  of 
the  fork  when  thus  placed  or^  the  vertex  of  the  skull. 

V.  MOUTH,  NOSE,  FAUCES,  PHARYNX,  LARYNX,  TRACHEA, 

AND  ESOPHAGUS. 

42.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing conditions,  who  are  otherwise  mentally  and  physically  fit, 
shall  be  unconditionally  accepted  for  general  military  service: 

(a)  Normal  conditions  of  the  mouth,  nose,  fauces,  pharynx,  larynx, 
trachea,  and  esophagus. 

83246°— 18 3 


18 

(5)   Enlarged  tonsils. 
(g)   Adenoids. 

(d)  Small  benign  tumors  of  the  nasal  and  buccal  mucous  mem- 
brane. 

(e)  Deviation  of  the  nasal  septum  Avhich  does  not  seriously  inter- 
fere with  nasal  breathing. 

(/)  Acute  primary  sinusitis  provided  the  acceptance  of  the  regis^. 
trant  is  temporarily  deferred  for  reexamination,  if  after  a  reasonable 
time  the  sinusitis  has  disappeared. 

(g)  Laryngitis  manifested  by  hoarseness,  laryngeal  cough,  and 
congestion  of  the  vocal  chords,  confirmed  by  laryngoscopy. 

(A)  Paralysis  of  the  vocal  chords,  if  it  appears  to  be  temporary  in 
character. 

(i)  Aphonia  without  objective  findings  by  laryngoscopy  or  other 
measures,  and  which  in  the  opinion  of  the  examiners  is  due  to  func- 
tional nervous  conditions. 

(_/■)  Alleged  stricture  of  the  esophagus  which  is  unattended  by 
evidence  of  organic  disease  of  the  eosOphagus  as  shown  by  the  passage 
of  a  stomach  tube  or  an  esophageal  bougie,  or  by  a  fluoroscopic  exam- 
ination while  the  regi&i:rant  is  swallowing  a  bismuth  mixture. 

43.  Eegistrants  who  on  examination  present  the  following  defects, 
who  are  otherwise  mentally  and  physically  fit,  may  be  accepted  for 
special  and  limited  military  service : 

(a)  Deviation  of  the  nasal  septum,  though  it  markedly  interferes 
with  nasal  breathing. 

(h)  Paralysis  of  the  vocal  chords,  and  which  does  not  appear  tem- 
porary in  character,  if  it  permits  the  registrants  to  follow  a  useful 
vocation  in  civil  life. 

(c)  Aphonia,  with  attendant  conditions,  which  disqualify  for 
general  military  service,  if  they  have  followed  a  useful  vocation  in 
civil  life. 

(d)  Partial  ankylosis  of  the  lower  jaw. 

(e)  Perforation  of  the  hard  palate. 

(/)  Moderate  deformity  of  the  structures  of  the  mouth  which 
does  not  seriously  interfere  with  mastication  or  speech. 

44.  Eegistrants  who  on  examination  present  the  following  defects 
shall  be  unconditionally  rejected  for  all  military  service : 

(a)  Irremediable  deformities  of  the  mouth,  throat,  and  nose  which 
interfere  with  the  mastication  of  ordinary  food,  with  speech,- or  with 
breathing. 

(5)  Tuberculosis  of  the  structures  of  the  mouth,  larynx,  fauces, 
nose,  or  esophagus. 

(<?)  Cancer  of  the  structures  of  the  mouth,  nose,  throat,  larynx, 
or  esophagus. 


19 

{d)  Destructive  syphilitic  diseases  of  the  mouth,  nose,  throat, 
larynx,  or  esophagus. 

{e)  Laryngeal  paralysis,  due  to  pressure  from  aneurysm  or  tumor. 

(/)  Permanent  tracheostomy. 

{g)  Stricture  of  the  esophagus. 

{h)  Permanent  gastrostomy. 

(^)  Chronic  sinusitis  of  the  accessory  sinuses  of  the  nose.  (The 
diagnosis  should  be  established  upon  chronic  nasal  discharge,  pres- 
ence of  large  nasal  polypi,  and  other  signs  and  symptoms  rein- 
forced by  transillumination  or  X-ray  plate,  or  both. 

{j)   Chronic  atrophic  rhinitis  with  offensive  odor.     (Ozena.) 

45.  When  the  Local  Boards  are  in  doubt  concerning  the  physical  fit- 
ness of  registrants  who  suffer  from  defects  of  the  mouth,  nose,  fauces, 
pharynx,  larynx,  or  esophagus,  they  should  he  referred  to  the  Medical 
Advisory  Boards,  or  to  a  member  or  members  thereof. 

46-  Medical  Advisory  Boards  should  make  use  of  laryngoscopy,  tran- 
sillumination of  the  head,  and  X-ray  plates,  when  available,  to  determine 
more  definitely  the  physical  fitness  of  registrants  who  have  defects  in- 
volving the  upper  air  passages,  head,  or  esophagus. 

VI.  DENTAL  REQUIREMENTS, 

47.  Registrants  v^ho  on  examination  are  found  to  present  the  fol- 
lowing conditions,  if  otherwise  mentally  and  physically  fit,  shall  be 
unconditionally  accepted  for  general  military  service : 

(«)   Normal  teetli. 

(6)  A  minimum  of  three  serviceable  natural  masticating  teeth 
above  and  three  below  opposing  and  three  serviceable,  natural  in- 
cisors above  and  three  below  opposing.  (Therefore,  the  minimum 
requirements  consist  of  a  total  of  six  masticating  teeth  and  of  six  in- 
cisor teeth.  All  of  these  teeth  must  be  so  opposed  as  to  serve  the 
purpose  of  incision  and  mastication.) 

48.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing defects,  who  are  otherwise  mentally  and  physically  fit,  may 
be  accepted  for  special  and  limited  military  service : 

(a)  Dental  defects  which  are  greater  than  the  minimum  dental 
requirements  for  general  military  service. 

DEFINITIONS. 

49.  {a)  The  term  "  masticating  teeth "  includes  molar  and  bi- 
cuspid teeth,  and  the  term  "  incisors "  include  incisor  and  cuspid 
teeth. 

(&)  A  natural  tooth  which  is  carious  (one  with  a  cavity)  which 
can  be  restored  by  filling  is  to  be  considered  as  a  natural  serviceable 
tooth. 


20 

(c)  Teeth  which  have  been  (bee  (5))  restored  by  crowns  or 
dummies  attached  to  fixed  bridge  work,  if  well  placed,  shall  be 
considered  as  serviceable  natural  teeth,  when  the  history  and  the 
appearance  of  these  teeth  is  such  as  to  clearly  warrant  such 
assumption. 

(d)  A  tooth  is  not  to  be  considered  a  serviceable,  natural  tooth 
when  it  is  involved  with  excessively  deep  pyorrhea  pockets  or  when 
its  root  end  is  involved  with  a  known  infection  that  has  or  has  not 
an  evacuating  sinus  discharging  through  the  mucous  membrane  or 
skin. 

50.  Physicians  and  dentists  of  Local  Boards  and  Medical  Advisory 
Boards  are  urged  to  advise  and  to  aid  registrants  with  remediable  carious 
teeth  and  infected  dental  roots  and  other  dental  defects,  to  have  them 
remedied  pending-  orders. 

51.  Instruct  them  that  all  hopelessly  diseased  teeth  should  be  extracted. 
Chronic  focal  infections  involving  the  teeth  and  jaws  should  be  eradi- 
cated and  all  tooth  cavities  should  be  filled.  This  preliminary  remediable 
dental  work  will  greatly  assist  the  dentists  of  the  cantonments  in  com- 
pleting the  routine  necessary  dental  work.  The  correction  of  the  focal 
infection  about  the  mouth  will  protect  the  registrants  from  possible 
systemic  complications  which  are  liable  to  occur  under  the  strain  of 
military  training. 

52.  When  the  physicians  of  the  Local  Boards  are  in  doubt  concerning 
dental  defects  of  registrants,  they  should  refer  them  to  the  Medical 
Advisory  Boards,  or  to  a  specialist  member  thereof. 

VII.  SKIN. 

53.  Eegistrants  who  on  examination  are  found  to  present  the  fol- 
lowing conditions,  if  otherwise  mentally  and  physically  fit,  sliall  be 
unconditionally  accepted  for  general  military  service: 

(a)   Normal  skin. 

(h)  Acute  diseases  of  the  skin  which  ordinarily  run  a  temporary 
course. 

(c)  Diseases  which  are  trivial  in  character  and  which  do  not  inter- 
fere with  the  general  health  and  are  not  incaj)acitating.  Among 
these  common  and  usually  trivial  diseases  may  be  enumerated: 

Acne. 

Anomalies  of  pigmentation. 

Scars  not  extensive,  disfiguring,  nor  inCapaciting  in  character. 

Condylomata  which  are  not  extensive. 

Staphylococcic  and  streptococcic  skin  infections. 

Acute  eczemas. 

Naevi  which  are  not  greatly  disfiguring. 

All  forms  of  pediculosis. 

All  forms  of  ringworm. 


21 

Scabies. 
.  Mild  and  not  extensive  psoriasis. 

Warts. 

The  secondary  syphilitic  lesions  of  the  skin. 

Registrants  who  are  accepted  for  general  military  service  with  tem- 
porary remediable  defects  in  the  form  of  parasitic  and  other  communi- 
cable diseases  of  the  skin  should  have  this  fact  noted  in  Form  1010. 
(See  Section  5.) 

54.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing defects,  who  are  otherwise  mentally  and  physically  fit,  may 
be  accepted  for  special  and  limited  military  service : 

(a)  Simple  ulcers  or  other  defects  of  the  skin  which  are  curable. 
(See  Par.  75  (s).) 

(h)  Defects  due  to  diseases  of  the  skin,  either  acute  or  chronic, 
which  disqualify  for  general  military  service,  if  the  registrants  have 
successfully  followed  a  useful  vocation  in  civil  life. 

55.  Registrants  who  on  examination  present  the  following  defects 
of  the  skin  shall  be  unconditionally  rejected  for  all  military  service: 

(a)  Long  existing  skin  diseases  or  long  existing  ulcers  of  the  skin 
which  are  so  severe,  or  so  disfiguring  as  to  incapacitate  the  regis- 
trant for  the  duties  of  a  soldier,  or  so  disfiguring  as  to  render  the 
registrant  objectionable  in  common  social  intercourse. 

(5)  Actinomycosis. 

(c)   Dermatitis  herpetiformis  of  long  duration. 

{d)   Epidermolysis  bullosa. 

(e)  Forms  of  universal  dermatitis  of  long  duration. 

(/)   Glanders. 

(g)  Idiopathic  multiple  hemorrhagic  sarcoma. 

(h)  Mycosis  fungoides. 

{!.)  Pemphigus  chronicus  of  long  duration. 

(j)   Pemphigus  foliaceous. 

(k)   Pemphigus  vegetans. 

(1)   Cancer,  including  pigmented  moles. undergoing  degeneration. 

(m)   Lupus. 

(n)  Syphilitic  lesions  ulcerative  in  character  showing  much  de- 
struction of  tissue  which  if  healed  would  be  unsightl}'  or  so  scarring 
as  to  incapacitate  the  registrants  for  military  service. 

56.  When  the  Local  Boards  are  in  doubt  concerning  the  physical  fit- 
ness of  registrants  who  suffer  from  defects  due  to  diseases  of  the  skin, 
they  should  refer  them  to  the  Medical  Advisory  Boards. 

VIIL  HEAD. 

57.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing conditions,  if  otherwise  mentally  and  physically  fit,  shall  be 
unconditionally  accepted  for  general  military  service: 

(a)   Normal  skull. 


22 

(b)  Moderate  deformities  of  the  bones  of  the  skull  of  the  char- 
acter of  depressions,  exostoses,  etc.,  and  unassociated  with  evidence 
of  disease  of  the  brain,  spinal  cord,  or  peripheral  nerves,  and  which 
would  not  prevent  the  registrant  from  wearing  military  headgear. 

(c)  Defects  which  are  apparently  temporary  in  character  due  to 
recent  injuries.  (This  includes  contusions  and  other  wounds  of  the 
scalp  and  concussion.  Registrants  with  these  defects  should  have  the 
final  examination  temporarily  deferred.) 

58.  Eegistrants  who  on  examination  are  found  to  present  the  fol- 
lowing defects,  who  are  otherwise  mentally  and  physically  fit,  may 
be  accepted  for  special  and  limited  military  service: 

(a)  Decompression  operation  of  the  skull  unassociated  with 
marked  bulging  at  the  site  of  operation. 

59.  Registrants  w^ho  on  examination  are  found  to  present  the  fol- 
lowing defects  shall  be  unconditionally  rejected  for  all  military 
service : 

(a)  Deformities  of  the  skull  of  the  nature  of  depressions,  exos- 
toses, etc.,  of  a  degree  which  will  prevent  the  registrants  from  wear- 
ing military  headgear. 

(5)  Deformities  of  the  skull  of  any  degree  associated  with  evi- 
dences of  disease  of  the  brain,  spinal  cord,  or  peripheral  nerves. 

IX.  SPINE. 

60.  Eegistrants  who  on  examination  are  found  to  present  the  fol- 
lowing, conditions,  who  are  otherwise  mentally  and  physically  fit, 
shall  be  unconditionally  accepted  for  general  military  service: 

(a)  Normal  spine. 

(b)  Lateral  curvature  of  the  spine  of  2  inches  or  less  from  the 
normal  mid  line,  if  the  mobility  and  weight-bearing  power  are  good. 

(d)  Temporary  defects  in  the  form  of  recent  contusions  or  sprains 
of  the  spinal  column. 

(e)  Pilo-nidal  sinus  (this  usually  presents  itself  in  the  region 
between  the  coccyx  and  anus)  if  unattended  with  disease  of  the  bone 
as  shown  by  an  X-ray  plate. 

(c)  Fracture  of  the  coccyx. 

61.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing defects,  who  are  otherwise  mentally  and-  physically  fit,  may 
be  accepted  for  special  and  limited  militar}^  service : 

(a)  Lateral  deviation  of  the  spine  from  the  normal  mid  line  of 
more  than  2  inches  and  less  than  3  inches. 

(b)  Nontuberculous  diseases  of  the  spine  which  are  unassociated 
with  such  rigidity  that  the  registrant  has  been  incapacitated  from 
following  a  useful  vocation  in  civil  life. 

(c)  Fracture  of  the  spine  or  pelvic  bones  which  have  healed 
without  defects  and  which  have  not  interfered  with  their  following 
a  useful  vocation  in  civil  life. 


23 

62.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing defects  shall  be  unconditionally  rejected  for  all  military 
service : 

(a)  Extensive  disease  of  the  vertebrse. 

(b)  Tuberculosis  of  any  portion  of  the  vertebral  column. 

(c)  Abscess  of  the  spinal  column. 

(d)  Osteoarthritis,  partial  or  complete,  of  the  spinal  column. 

(e)  Healed  fractures  of  the  vertebrse  or  pelvic  bones  with  associ- 
ated disqualifying  rigidity. 

(/)  Lateral  deviation  of  the  spine  from  the  normal  mid  line  of 
more  than  3  inches. 

63.  When  the  Local  Boards  are  in  doubt  concerning  the  physical  fit- 
ness of  registrants  who  suffer  from  deformities  and  diseases  of  the  spine, 
they  shall  refer  them  to  the  Medical  Advisory  Boards,  or  to  a  member  or 
members  thereof. 

64.  Eegistrants  who  appear  for  examination  wearing  a  plaster  jacket 
should  be  referred  to  the  Medical  Advisory  Boards,  or  to  a  member  or 
members  thereof.  The  jacket  should  not  be  removed  until  provision  shall 
have  been  made  for  its  reapplication. 

65.  When  the  physicians  of  the  Medical  Advisory  Boards  are  in  doubt 
concerning  the  cause  and  the  extent  of  the  diseases  of  the  vertebras,  an 
X-ray  plate  of  the  spine  should  be  made. 

SACRO-ILIAC  AND  LUMBO-SACRAL  JOINTS. 

66.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing conditions,  if  otherwise  mentalh'  and  physically  fxt,  shall  be 
unconditionally  accepted  foi''  general  military  service: 

(a)   Normal  sacro-iliac  and  lumbo-sacral  joints. 

(h)  Complaint  of  disease  of  the  sacro-iliac  and  lumbo-sacral  joints 
which  is  unassociated  with  objective  signs  and  symptoms  at  the 
first  examination  and  which,  on  reexamination,  after  a  reasonable 
period  of  time,  is  again  found  negative. 

67.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing defect,  if  otherwise  mentally  and  physica^Uy  fit,  may  be 
accepted  for  special  and  limited  military  service : 

(a)  Disease  of  the  sacro-iliac  and  lumbo-sacral  joints  of  a  degree 
which  disqualifies  for  general  military  service,  if  otherwise  mentall}' 
and  physicall}"  fit  and  if  the  registrants  have  followed  a  useful  voca- 
tion in  civil  life. 

68.  Registrants  who  on  examination  are  found  to  suffer  from  the 
following  defect  shall  be  unconditionally  rejected  for  all  military 
service : 

(a)  Disease  of  the  sacro-iliac  and  lumbo-sacral  joints  v.diich  is  of  a 
chronic  type  and  is  obviously  associated  with  pain  referred  to  the 


24 

lower  extremities,  muscular  spasm,  postural  deformities,  and  limita- 
tion of  motion  in  the  lumbar  region  of  the  spine. 

69.  When  Local  Soards  are  in  doubt  concerning  the  physical  fitness 
of  registrants  who  snl?er  from  disease  or  other  defects  of  the  sacro-iliac 
or  lumbo-sacral  joints,  they  shall  be  referred  to  the  Medical  Advisory 
Boards,  or  to  a  member  or  members  thereof. 

X.  SCAPULAE. 

70.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing conditions,  if  otherwise  physically  and  mentally  fit,  shall  be 
unconditionally  accepted  for  general  military  service: 

(a)   Normal  scapulae. 

( h )   Prominent  scapulae  due  to  other  causes  than  paralysis. 

71.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing defect  shall  be  unconditionally  rejected  for  all  military  service : 

(a)  Prominent  scapula?  due  to  paralysis. 

XL  THE  EXTREMITIES. 

72.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing conditions  shall  be  unconditionally  accepted  for  general  mili- 
tary service: 

(a)  Normal  upper  and  lower  extremities  with  normal  function. 
(h)  Ancient  or  recent  fractures  which  have  healed  spontaneously 
with  no  resulting  impairment  of  function. 

(c)  Parah^sis  of  a  muscle  or  group  of  muscles  that  does  not  inter- 
fere with  function.     (See  Section  128.) 

(d)  Benign  tumors  of  bone  or  defects  due  to  their  removal  when 
the  condition  does  not  interfere  with  the  function  of  the  extremity 
or  the  joint  involved. 

(e)  Recent  injury  of  a  bone  or  joint  with  or  without  fracture  or 
dislocation  which  in  the  opinion  of  the  examiners  is  only  temporarily 
incapacitating.  (Registrants  with  these  defects  should  be  given  a 
period  of  time  not  less  than  six  weeks  for  recovery  before  the  final 
examination  is'  made.) 

(/)  Defects  of  bone  or  joint  due  to  healed  tuberculosis  when  the 
tuberculosis  has  not  shown  evidence  of  activity  at  any  time  during  the 
period  of  10  years  immediately  preceding,  the  examination. 

(g)  Absent  left  thumb. 

(A)  Loss  of  one  finger  of  either  hand,  with  the  exception  of  the 
right  index  finger. 

(i)  Scars  and  deformities  of  moderate  degree  of  the  hand  or  hands 
which  do  not  interfere  with  normal  function. 

(j)  Stiff  fingers-  of  a  degree  not  to  interfere  with  function. 

(k)  A  low  or  even  absent  longitudinal  arch  if  tlie  foot  is  otherwise 
practically  normal  in  shape,  flexibility,  and  weight-bearing  capacity. 


25 

(l)  Slight  hallux  valgus  which  is  unassociatcd  with  exostoses  or 
bunion  of  any  size. 

(m)  Clubfoot  of  slight  degree  if  the  deformity  has  been  corrected 
to  the  degree  that  the  tarsus,  metatarsus,  and  phalanges  are  flexible 
and  the  condition  permits  the  wearing  of  a  military  shoe. 

(n)  Slight  claw  toes  not  involving  obliteration  of  the  transverse 
arch  and  which  do  not  interfere  with  the  Avearing  of  a  military  shoe. 

(o)  Hammer  toe  which  is  flexible  and  which  does  not  interfere 
with  the  wearing  of  a  military  shoe.  (Hammer  toe  usually  involves 
the  second  digit  and  unless  it  is  rigid  is  not  a  disqualifying  defect.) 

(p)  Absence  of  one  or  two  of  the  small  toes  of  one  or  both  feet 
if  the  function  of  the  foot  is  good. 

(q)   Ingrowing  toenails. 

73.  Eegistrants  who  on  examination  present  the  following  remedia- 
ble defects,  who  are  otherwise  mentally  and  physically  fit,  may  be 
conditionally  accepted  for  general  military  service  in  the  deferred 
remediable  group : 

(a)  Ununited  fractures  if  in  the  judgment  of  the  examiners  they 
are  remediable  with  resultiiig  good  function. 

(b)  Benign  tumors  of  bone  or  joint  which  interfere  with  function 
and  wdiich  in  the  judgment  of  the  examiners  are  remediable. 

(c)  Other  defects  which  in  the  opinion  of  the  examiners  are  dis- 
qualifying but  remediable. 

74..  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing defects,  who  are  otherwise  mentally  and  physically  fit,  may 
be  accepted  for  special  and  limited  military  service,  unless  the  degree 
of  disability  is  obviously  disqualifying: 

(a)   Loss  of  thumb  or  index  finger  of  right  hand. 

(h)  Loss  of  two  fingers  of  either  hand,  including  the  right  index 
finger. 

(c)  Web  fingers. 

(d)  Ganglion  and  other  benign  tumors  of  the  hand  or  fingei's. 

(e)  Moderate  deformities  of  one  or  both  upper  extremities  Avhich 
do  not  and  have  not  interfered  with  function  to  a  degree  to  prevent 
the  registrant  from  following  a  useful  vocation  in  civil  life. 

(/)   Internal  derangement  of  the  knee  joint. 

(ff)  Abduction  and  pronation  (knock-ankle)  when  this  condition 
is  not  associated  with  rigidity  of  the  tarsal  joints  or  Avith  deforniit}' 
of  the  foot.  (This  defect  is  remediable  with  proper  foot  exercises 
and  w^ith  correct  shoes.) 

(h)  Loss  of  great  toe.  • 

(i)  Loss  of  dorsal  flexion  of  great  toe. 

(_/')   Hammer  toe  with  rigidity. 

(k)  Web  toes. 
83246°— 18 4 


26 

(l)  Other  defects  of  the  foot  which  disqualify  for  general  mili- 
tary service  but  do  not  prevent  the  registrant  from  wearing  a  military 
shoe  and  which  have  not  prevented  him  from  following  a  useful  voca- 
tion in  civil  life, 

(m)  Moderate  deformities  of  one  or  both  lower  extremities  which 
do  not  and  have  not  interfered  with  function  to  a  degree  to  j:)  re  vent 
the  registrant  from  following  a  useful  vocation  in  civil  life. 

(n)  Adherent  scars  of  the  skin  and  soft  tissues  of  an  extremity. 

(0)  Paralj^sis  of  a  muscle  or  group  of  muscles  that  interferes  with 
function.     (See  Section  128.) 

75.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing defects  shall  be  unconditionally  rejected  for  all  military 
service : 

(a)  Loss  of  both  thumbs. 

(h)  Loss  of  more  than  two  entire  fingers  of  one  hand. 

(c)  Extensive  disease  of  long  duration  of  one  or  more  of  the  large 
joints  with  or  without  sinuses. 

(d)  Tuberculosis  of  a  bone  or  joint.  (The  diagnosis  should  be 
based  upon  the  presence  of  swelling,  tenderness,  muscular  spasm,  re- 
striction of  joint  motion,  and  the  evidence  of  bone  destruction  shown 
by  an  X-ray  plate.) 

(e)  A  history  of  tuberculosis  of  a  bone  or  joint  when  the  tuber- 
culosis has  been  active  at  some  time  during  the  period  of  10  years 
prior  to  the  examination. 

(/)  Old,  irremediable,  ununited  fractures  or  united  fractures  wi(h 
deformity  sufficient  to  interfere  markedlj"  with  function. 

(g)  Malignant  tumors. 

(A)  Extensive  disease  of  long  duration  involving  a  number  of 
joints  of  the  upper  and  lower  extremities. 

(i)  Old,  unreduced  dislocations  which  have  interfered  with  the 
registrant  following  a  useful  vocation  in  civil  life, 

(j)  Disease  of  the  shoulder,  elbow,  or  wrist  with  resulting  limita- 
tion of  motion. 

(k)  Disease  of  bone  or  joint  healed  with  such  resulting  deformity 
that  the  function  is  disturbed  to  a  degree  that  it  will  interfere  with 
military  service. 

(1)  Muscle  paralysis  or  contraction  which  disturbs  function  to 
the  degree  of  interference  with  military  service. 

(m)  Excessive  curvature  of  the  bones  of  the  forearm  or  arm  which 
would  interfere  with  military  drill. 

(n)  Excessive  curvature  of  the  bon^  of  the  leg  or  thigh. 

(o)  Excessive  knock-knee. 

(p)  Excessive  bow  legs. 

(q)  Adherent  scars  of  skin  or  soft  tissue  to  a  degTee  which  seri- 
ously interferes  with  function. 


(r)  Excessive  varicose  veins. 

(.s)  Varicose  veins  of  any  degree  associated  Avitli  edema  or  ulcer 
of  the  skin. 

(t)  Absent  longitudinal  arch  of  the  foot  associated  with  one  or 
more  of  the  following  conditions : 

Limitation  of  dorsal  flexion. 

Eigid  metatarsal  and  subastragaloid  joints. 

Rigid  toes. 

Marked  pronation. 

Prominent  scaphoid  associated  with  other  disabling  foot  condi- 
tions. 

(u)  Rigidity  of  the  tarsus  and  metatarsus  due  to  former  infec- 
tious processes,  with  or  without  flat  foot. 

(r)  Obliteration  of  the  transverse  arch  associated  with  permanent 
flexion  of  the  small  toes  (claw  toes). 

(w)  Prominence  of  the  plantar  surface  of  the  transverse  arch 
especially  when  associated  with  large  callosities. 

(cc)  Abnormal  flaccidity  of  the  foot  and  toes  when  associated 
with  evident  severely  painful  symptoms. 

(y)  Abduction  and  pronation  (knock-ankle)  when  associated  with 
rigidity  of  the  tarsal  joints  and  painful  symptoms. 

(0)  Hallux  valgus  if  severe  and  associated  with  exostoses  or  a 
bunion  of  any  considerable  size,  especially  when  there  are  signs  of 
irritation  about  the  joint. 

(aa)  Club  foot,  if  correction  of  the  condition  has  not  been  suffi- 
cient to  meet  the  standard  requirements.     (See  par.  72  (m).) 

(hh)  Disease  of  tlie  bone  or  of  the  hip,  knee,  or  ankle  joint  which 
seriously  interferes  with  function  and  weight-bearing  power. 

(cc)  Deformities  due  to  fracture  or  other  injur}'  which  seriously 
interfere  with  function  and  weight-bearing  power. 

(dd)  Sciatica,  which  is  apparently  intractable  and  disabling,  to 
the  degree  of  interference  with  the  function  of  walking  and  weight- 
bearing  power. 

(ee)  Amputations  of  extremities  in  excess  of  those  already  cited. 
(See  par.  4  (/).) 

76.  The  selection  of  reg-istrants  with  defects  of  the  feet  for  special  or 
limited  military  service  must  be  left  to  the  judgment  of  the  physicians 
of  the  Local  Boards  and  Medical  Advisory  Boards. 

77.  It  is  extremely  important  that  registrants  with  defects  of  the  feet 
which  are  not  remediable  by  training  and  which  prevent  the  inducted 
men  from  taking  proper  training,  should  not  be  accepted  for  general 
military  service.  It  is  quite  as  important  that  defects  of  the  feet,  which 
are  not  disabling,  should  not  be  considered  disqualifying  for  general 
military  service. 


28 

XII.  HEIGHT,  WEIGHT,  AND  CHEST  MEASUREMENTS. 

78.  Table  of  standard  accepted  measurements  of  height,  weight, 
and  circumference  of  chest.     (See  Section  5.) 

A.  standard  accepted  measurements. 


Height. 

Weight. 

Chest  measure- 
ment. 

At  ex- 
piration. 

Mobil- 
ity. 

Inches. 
60 

Pounds. 
120 
120 
120 
124 
128 
130 
132 
134 
141 
148 
155 
162 
169 
176 
183 
190 
197 
204 
211 

Inches. 
31 
31 
31 
31 
32 
32 
32i 
33 
33} 
33i 
34 
34} 
34J 
35} 
36} 
36| 
371 
37J 
38} 

Inches. 
2 
2 
2 
2 
2 
2 
2 
2 
2i 
2i 
24 

f 

3 

3 

3i 

3i 

f 

61 

62 

63 

64 

65 

66 

67 

68 

69 

70 

71...       . 

72 

73 

74 

75 

76 

77... 

78 

B.  The  foUowing  variations  from  the  standard  shoii-n  in  column  A  are  per- 
missible iohen  the  applicant  is  active,  has  firm  muscles,  and  is  evidently 
vigorous  and  healthy. 


Height. 

Weight. 

Chest  measure- 
ment. 

At  ex- 
piration. 

Mobil- 
ity. 

Inches. 
60       

Pounds. 
110 
110 
110 
116 
120 
120 
120 
120 
121 
124 
128 
133 
138 
143 
148 
155 
161 
108 
175 

Inches. 
30 
30 
30 
30 
30 
30 
30} 
30i 

m 

31 

31} 

31J 

32} 

.32J 

33h 

34} 

34f 

35} 

35i 

Inches. 
2 
2 
2 
2 
2 
2 
2 
2 
2 
2. 
2 
2 
2h 
2h 
2J 
2f 

r 

3 

61 

62 

63 

64 

65 

66 

67 

68 

69 

70 

71 

72       

73 

74 

75 

76 

77 

78 

79.  Directions  for  tahing,  height. — Use  a  board  at  least  2  inches 
wide  by  80  inches  long,  placed  vertically,  and  carefully  graduated 
to  one-quarter  inch  between  58  inches  from  the  floor  and  the  top 
end.     Obtain  the  height  by  placing  vertically  in  firm  contact  with 


29 

the  top  of  the  head  and  against  the  measuring  rod  an  accurately 
squared  board  of  about  6  by  6  by  2  inches — best  permanently  at- 
tached to  graduated  board  by  a  long  cord.  The  registrant  should 
stand  erect  with  back  to  the  graduated  board,  eyes  straight  to  the 
front. 

80.  Registrants  who  on  examination  present  the  following  condi- 
tions, if  otherwise  mentally  and  physically  fit,  shall  be  unconditionally 
accepted  for  general  military  service. 

(a)  Those  who  fall  within  the  accepted  standards  (A)  or  mini- 
mum requirements  (B)  for  height,  v.eight,  and  chest  measurement 
given  in  tables,  paragraph  78. 

(b)  Those  whose  weight  is  greater  than  the  standards  indicated 
for  the  height  (A)  provided  the  overweight  is  not  so  excessive  as  to 
interfere  with  military  training. 

81.  Registrants  wdio  on  examination  are  found  to  present  condi- 
tions not  within  the  accepted  measurements  for  weight  and  chest 
circumference  and  mobility  given  in  the  table,  who  are  otherwise 
mentally  and  physically  fit,  may  be  accepted  for  special  or  limited 
military  service.  But  no  registrant  may  be  accepted  whose  weight  is 
less  than  110  pounds. 

82.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing defects  shall  be  unconditionally  rejected  for  all  military 
service : 

(a)   Less  than  60  inches  in  height. 
(5)   Less  than  110  pounds  in  weight. 

(c)  With  a  chest  measurement  of  less  than  30  inches  and  chest 
mobility  of  less  than  2  inches. 

(d)  A  height  of  more  than  78  inches. 

(e)  Overweight  which  is  greatly  out  of  proportion  to  the  height, 
if  it  interferes  with  normal  physical  activity  or  with  proper  training. 

83.  Local  Boards  should  refer  to  the  Medical  Advisory  Boards  the  fol- 
lowing registrants: 

(a)  Registrants  who  on  examination  are  found  to  be  apparently 
slight!}'  under  the  minimum  requirements  for  weight  and  chest  meas- 
urements in  their  relation  to  the  height; 

(h)  Registrants  of  76  inches  or  more  in  height  who  should  be 
studied  for  the  possibility  of  gigantism  or  acromegaly. 

(c)  Registrants  who  are  obese. 

(d)  Registrants  whose  weight  is  slightly  under  the  minimum  with 
respect  to  height,  in  whom  the  defect  is  due  to  recent  illness  or  to 
employment  and  environment  of  civil  life  and  may  be  considered 
remediable  by  camp  life. 

(e)  Registrants  whose  chest  mobility  is  less  than  2,  2|,  or  3  inches, 
respectively,  as  per  the  table,  that  they  may  be  further  studied  to 


30 

ascertain  if  the  lack  of  required  chest  mobility  is  due  to  ignorance  or 
to  lack  of  practice. 

84.  Physicians  of  Local  Boards  and  Medical  Advisory  Boards  should 
use  discretion  and  judgment  in  accepting  registrants  with  slight  varia- 
tions in  the  ratio  of  height,  v/eight,  and  chest  measurements  indicated 
in  the  table.  Minimum  and  maximum  height  are  absolute,  but  when  the 
weight  is  disproportionate  and  is  believed  to  be  due  to  some  temporary 
condition,  proper  allowance  may  be  m-ade,  provided  it  is  the  opinion  of 
the  boards  that  the  variation  is  correctable  with  proper  food  and  physical 
training.  But  no  registrant  may  be  accepted  whose  weight  is  less  than 
110  pounds. 

XIII.  ABDOMEN. 

85.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing conditions,  who  are  otherwise  mentally  and  physically  fit, 
shall  be  unconditionally  accepted  for  general  military  service: 

(a)  Normal  abdominal  wall  and  abdominal  organs. 

(b)  Abdominal  scars  due  to  surgical  operation  or  accident  which 
show  no  hernial  bulging  at  site  of  scars. 

(c)  Scar  pain  when  found  not  associated  with  any  disturbance  of 
function  of  abdominal  wall,  stomach,  or  bowels. 

(cZ)  Jaundice  when  this  is  proved  to  be  of  a  temporary  character 
and  not  associated  with  organic  disease  of  the  gall  tracts  or  liver,  by 
observation  and  reexamination  of  the  registrant  over  a  period  of 
one  month. 

(e)  Complaint  of  weak  stomach,  indigestion,  dyspepsia,  constipa- 
tion, belching,  vomiting,  and  various  other  types  and  degrees  of 
abdominal  discomfort  which  are  proven  by  examination  not  to  be 
associated  with  organic  disease,  by  the  absence  of  the  usual  objective 
symptoms  and  signs  and  by  such  laboratory  tests  as  may  be  employed. 

(/)  Blood  in  stools  if  proved  to  be  due  to  slight  defects,  such  as 
fissures  of  the  anus,  small  hemorrhoids,  or  superficial  small  ulcers  of 
the  rectum. 

{(j)  Moderate  enlargement  of  the  liver  unassociated  with  other 
objective  evidence  of  disease  of  the  liver  or  other  organs. 

(h)  Splenic  enlargement  of  moderate  degree  unassociated  with 
evidence  of  other  disqualifying  disease. 

{i)  Moderate  enlargement  of  the  spleen  due  to  malaria. 

(j)   Small  benign  tumors  of  the  abdominal  wall. 

(/.;)  Ptosis  of  the  stomach  and  bowels  unassociated  with  objective 
evidence  of  disturbance  of  function  of  the  gastrointestinal  tract. 
(Individuals  who  have  ptosis  of  the  stomach  and  bowels  usually 
complain  of  constipation,  belching  of  gas,  heaviness  in  abdomen  after 
meals,  and  numberless  symptoms  referable  to  the  heart  and  nervous 
apparatus.) 


31 

(Z)   Mucous  colitis  of  simple  character. 

{m)   Proctitis  of  simple  character  confirmed  by  proctoscopy,  which 
is  not  associated  with  ulceration  of  the  mucous  membrane. 
{n)  Intestinal  parasites  or  their  eggs  in  the  stools. 
{o)   Internal  and  external  hemorrhoids  without  prolapse  of  rectum. 

86.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing remediable  defect,  who  are  otherwise  mentally  and  physically 
fit,  may  be  conditionally  accepted  for  general  military  service  in  the 
deferred  remediable  group : 

{a)   Partial  obstruction  of  the  bowel  not  due  to  organic  disease. 

87.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing defects,  who  are  otherwise  mentally  and  physically  fit,  may 
be  accepted  for  special  and  limited  military  service,  unless  the  degree 
of  disability  is  obviously  disqualifying : 

(«)   Hernia — inguinal,  femoral,  umbilical,  and  postoperative. 

(5)  Large  benign  tumors  of  the  abdominal  wall. 

{c)  Jaundice  which  persists  beyond  a  period  of  one  month  and  is 
determined  at  the  final  examination  to  be  remediable. 

{d)   Internal  hemorrhoids  with  prolapse  and  hemorrhage. 

(e)   Proctitis  associated  with  remediable  ulcers. 

(/)  Amebic  dysentery. 

{g)   Simple  fistula  in  ano. 

{h)  Ptosis  of  the  stomach  and  bowels  associated  with  disqualifying 
conditions  for  general  military  service,  but  which  permit  the  regis- 
trants to  follow  a  useful  occupation  in  civil  life. 

88.  Registrants  Avho  on  examination  present  the  following  defects 
shall  be  unconditionally  rejected  for  all  militarj'-  service : 

{a)   Inoperable  hernia. 
(5)   Irremediable  diseases  of  the  stomach. 
{c)  Irremediable  diseases  of  the  bowels. 
{d)  Irremediable  diseases  of  the  liver. 
(e)  Irremediable  diseases  of  the  kidney. 
(/)   Achylia  gastrica. 
{g)  Gastric  succorrhea. 
(h)   Syphilis  of  the  liver, 
(i)   Hydatids  of  the  liver. 
{})   Ulcer  of  the  stomach  or  duodenum. 
{h)   Obstruction  of  the  bowel  due  to  organic  disease. 
(7)   Chronic  gastritis  secondary  to  organic  diseiise  of  other  organs, 
(m)   Irremediable  sinuses  of  the  abdominal  wall  communicating 
with  the  hollow  viscera. 
{n)  Tuberculosis. 

{o)  Irremediable  stricture  of  the  rectum. 
(/?)   Multiple  fistulse  of  the  anus. 
{(j)   Schistosomum  disease  (blood  flukes). 


32 

(r)  Enlargement  of  the  spleen  associated  with  leukemia,  Hodg- 
kin's  disease,  or  splenic  anemia. 

(s)   Great  enlargement  of  the  spleen  from  any  cause. 

(t)  Large  internal  and  external  hemorrhoids  associated  with  pro- 
lapse of  the  rectum. 

(u)  Paralysis  of  the  sphincter  associated  with  incontinence  of 
feces. 

89.  When  the  physicians  of  Local  Boards  are  in  doubt  concerning  the 
physical  fitness  of  registrants  who  present  defects  of  the  abdominal  wall 
or  abdominal  organs,  they  shall  refer  them  to  the  Medical  Advisory 
Boards,  or  to  a  member  or  members  thereof. 

90.  When  necessary  to  confirm  a  diagnosis.  Medical  Advisory  Boards 
should,  when  possible,  avail  themselves  of  fiuoroscopy  and  X-ray  plates 
when  examining  registrants  with  defects  of  the  abdominal  wall  or  ab- 
dominal organs. 

91.  Wlien  the  Medical  Advisory  Boards,  or  their  members,  are  able  to 
command  hospital  facilities  and  the  necessary  diagnostic  appratus,  they 
should,  within  their  discretion,  use  test  meals  and  chemical  and  micro- 
scopic examination  of  the  stomach  contents  and  stools- 

92.  Physicians  of  Local  Boards  and  Medical  Advisory  Boards  should 
make  use  of  digital  rectal  examination  of  defects  referable  to  that  region, 
and  when  necessary  proctoscopy  should  also  be  utilized. 

93.  Registrants  who  are  found  to  have  parasites  or  their  eggs  in  stools 
should  have  this  condition  indicated  on  Form  1010. 

94.  Moderate  impulse  produced  by  cough  at  the  inguinal,  femoral, 
jll:^^  or  umbilical  rings,  or  at  the  site  of  a  scar  is  not  necessarily  indica- 
tive of  hernia. 

XIV.  NECK. 

95.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing conditions,  who  are  otherwise  mentally  and  phj'sically  fit, 
shall  be  unconditionally  accepted  for  general  military  service : 

(a)  Normal  neck. 

(b)  Nonspastic  contraction  of  the  muscles  of  the  neck  which  is  not 
of  great  degree  and  will  not  prevent  the  wearing  of  a  uniform  or 
militar}^  equipment. 

(c)  Simple  goiter  or  benign  thyroid  tumors  unassociatcd  with 
toxic  symptoms  provided  the  enlargement  of  the  thyroid  will  not 
interfere  with  the  wearing  of  a  uniform  or  military  equipment. 

(d)  Benign  tumors  and  cj'^sts  of  the  neck  which  will  not  interfere 
with  the  wearing  of  a  uniform  or  military  equipment, 

(e)  Small,  benign  tumors  of  the  parotid  gland  which  will  not  in- 
terfere with  the  wearing  of  a  uniform  or  military  equipment. 


33 

(/)  Enlarged  lymph  glands  of  the  neck  vrhich  apparently  do  not 
interfere  with  the  general  health  and  which  are  not  large  enough  to 
interfere  with  the  wearing  of  a  uniform  or  military  equipment. 

96.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing remediable  defects,  who  are  otherwise  mentally  and  phys- 
ically fit,  may  be  conditionally  accepted  for  general  militai*y  service 
in  the  deferred  remediaJble  group. 

(a)  Simple  goiter  or  benign  tumors  unassociated  with  toxic  symp- 
toms but  so  large  as  to  interfere  with  wearing  a  uniform  or  military 
equipment. 

(o)  Enlarged  lymph  glands  of  the  neck  which  are  so  hirge  as  to 
interfere  with  wearing  a  uniform  or  military  equipment. 

(c)  Benign  tumors  and  cj^sts  of  the  neck  which  are  so  large  as  to 
interfere  with  the  wearing  of  a  uniform  or  military  equipment. 

(d)  Large  benign  tumors  of  the  parotid  gland  which,  in  the  opin- 
ion of  the  examiners,  may  be  removed  without  permanent  paralysis 
of  the  seventh  nerve. 

97.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing defects  shall  be  nncoriditionally  rejected  for  all  military  service : 

(a)  Exophthalmic  goiter. 

(&)  Thyroid  enlargement  from  any  cause  associated  with  toxic 
symptoms. 

(c)  Enlargement  of  the  lymph  glands  of  the  neck  associated  with 
all  clinical  types  of  leukemia  and  Hodgkin's  disease. 

(d)  Lympho-sarcoma. 

(e)  Tuberculous  glands. 
(/)  Malignant  tumors. 
(g)  Myxedema. 

(h)  Xonspastic  contraction  of  the  muscles  of  the  neck  which  is 
disfiguring  and  unsightly  or  interferes  with  wearing  a  uniform  or 
military  equipment. 

(i)  Spastic  contraction  of  the  m.uscles  of  the  neck. 

98.  When  Local  Boards  are  in  doubt  concerning  the  physical  fitness 
of  registrants  who  present  defects  of  the  neck,  they  should  refer  them  to 
the  Medical  Advisory  Boards,  or  to  a  member  or  members  thereof. 

99.  The  physicdans  of  Local  Boards  and  the  Medical  Advisory  Boards 
should  reject  all  registrants  who,  after  careful  study,  are  proved  to 
suffer  from  thyroid  toxic  symptoms. 

XV=  GBNITO-URINARY  ORGANS  AND  VENEREAL 

DISEASES, 

100.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing conditions,  who  are  otherwise  mentally  and  phj'sically  fit, 
shall  be  unconditionally  accepted  for  general  military  service: 

83246°— 18 5 


34 

(a)  Gonorrhea,  acute  or  chronic,  imcomplicatecl.     (See  Section  5.) 
(h)   Syphilis  witli  remediable  manifestations.     (See  Section  5.) 

(c)  Chancroids  and  the  resulting  infection  of  the  lymph  glands  of 
the  groin.  (If,  in  the  opinion  of  the  examiners,  registrants  suffering 
from  this  defect  are  in  a  condition  which  would  make  it  unsafe  to 
themselves  and  to  other  soldiers  in  the  cantonment,  their  induction 
should  be  temporarily  deferred  until  the  condition  is  improved.) 
(See  Section  5=) 

(d)  Gonorrheal  arthritis  which  is  determined  to  be  temporary  in 
character  and  not  of  itself  disqualifying.     (See  Section  5.) 

(e)  Moderately  movable  kidney.  (By  this  is  meant  a  kidney  which 
upon  deep  inspiration  may  be  palpated  below  the  costal  margins  and 
which  is  not  loose  within  the  abdominal  cavity. 

(/)  Albuminuria  with  or  without  casts  which  is  proved  by  observa- 
tion and  repeated  examination  to  be  temporary  in  character. 

(g)  Absence  of  one  or  both  testicles  due  to  removal  or  atrophy. 

(A)  Acute  cystitis  which  has  proved  to  be  of  a  temporary  char- 
acter by  observation  and  repeated  examination  over  a  period  not  to 
exceed  six  weeks. 

(^)   Phimosis  with  or  without  adhesions  of  the  mucus  surfaces. 

(_/')  Benign  warts  and  other  benign  growths  of  the  glans  penis 
and  of  the  prepuce. 

(k)  Amputation  of  the  penis  if  a-  sufficient  amount  of  the  organ 
remains  so  as  not  to  interfere  with  the  function  of  micturition. 
(Care  should  be  taken  to  fully  examine  registrants  who  present 
evidence  of  a  recurrence  of  a  disqualifying  disease  for  which  the 
amputation  was  made.) 

(?)   Varicocele  of  moderate  size. 

(m)  Hj^clrocele  of  modei^ate  size. 

(n)  Undescended  testicle  which  lies  within  the  al^dominal  cavity. 

101.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing remediable  defects,  who  are  otherwise  mentally  and  physically 
fit,  may  be  conditionally  accepted  for  general  military  service  in  the 
deferred  remediable  group : 

(a)  Cystitis,  chronic,  severe,  which  is  remediable  within  the  judg- 
ment of  the  examiners.  » 

(h)  Pyelitis  which  has  been  verified  by  cystoscopy  and  is  deemed 
remediable  by  the  examiners. 

(c)  Hj'drocele  of  very  large  size. 

(d)  Chronic  gonorrheal  vesiculitis  or  prostatitis. 

102.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing defects,  who  are  otherwise  mentally  and  physically  fit,  may 
be  accepted  for  special  and  limited  military  service: 

(a)    Stricture  of  the  urethra. 

(6)  Renal  or  ureteral  calculus  verified  by  an  X-ray  plate  and 
■with  no  evidence  of  disease  of  the  kidneys. 


35 

(c)  Benign  tumor  of  the  testicles. 

(d)  Cystitis,  subacute  or  chronic,  of  mild  grade. 
(6')   Benign  tumor  of  the  bladder. 

(/)   Varicocele  of  large  ^3izc. 

(g)   Hydrocele,  unless  of  very  large  size, 

(h)   Floating  kidney.      (By  floating  kidney  is  meant  one  which' 
is  freely  movable  within  the  abdominal  cavity.) 

(i)   Undescended  testis  which  lies  within  the  inguinal  canal. 

{])   Removal  of  one  kidney,  the  remaining  one  being  healthy. 

(/t)   Bed  wetting. 

103.  Iveyistrants  who  on  examination  are  found  to  present  the  fol- 
lowing  defects  shall  be  unconditionally  rejected  for  all  military  service : 

(a)  Chronic  nephritis.  (This  should  be  evidenced  by  the  presence 
in  the  urine  of  albumin  and  casts  Avith  or  without  blood,  over  a 
j)eriod  of  time  sufficient  to  prove  the  persistency  of  the  urinary  find- 
ings. The  examiners  should  require  the  registrants  to  void  the  urine 
during  the  period  of  the  examination  and  in  the  presence  of  the 
physicians.)  When  albumin  and  casts  are  found  in  the  urine  the 
registrants  should  be  reexamined  not  less  than  twice  on  separate 
diijs.  If  the  urine  shows  albumin  and  casts  with  or  without  blood 
and  this  condition  of  the  urine  is  associated  with  enlargement  of  the 
left  heart,  high  blood  pressure,  and  other  evidences  of  cardio-vas- 
cular  disease,  the  diagnosis  of  chronic  nephritis  may  be  made  imme- 
diately. If  the  presence  in  the  urine  of  albmnin  and  of  casts  with  or 
without  blood  is  proved  to  1)e  inconstant  and  if  the  condition  is 
unassociated  with  the  cardio- vascular  conditions  mentioned,  decision 
should  lie  within  the  judgment  and  discretion  of  the  examiners. 

(h)  Diabetes,  evidenced  by  the  presence  of  glucose  in  the  urine. 
(Reexamination  of  the  urine  of  registrants  which  on  the  first  ex- 
amination is  found  to  contain  glucose  should  be  made  over  a  period 
of  two  or  three  days.  The  registrants  should  void  the  urine  in  the 
presence  of  the  physicians.) 

(<■)   Irremediable  stricture  of  the  urethra. 

(d)   Urinarj^  fistula. 

{'/)   Gonorrheal  arthritis  which  is  of  itself  disciualifving. 

(/)    Surgical  kidney  with  or  Avithout  renal  calculus. 

(fj)   Irremediable  pyelitis. 

(h)   Cancer. 

(i)   Hydronephrosis. 

(j)   Tumors  of  the  kidney. 

(/>■)  Tuberculosis  of  the  kidney,  ureter,  bladder,  seminal  vesicles, 
or  testicles. 

(7)  Acute  nephritis  which  is  proved  by  obserA'ation  and  reexami- 
nation not  to  be  temporary  in  chaiacter. 


36 

(m)  Chronic  cystitis  associated  witli  retention  of  urine  caused  by 
stricture  of  the  uretlira  or  by  disease  of  the  central  nervous  system. 

(n)  Amputation  of  the  penis  if  the  resulting  stump  is  insufficient 
to  permit  of  normal  function  of  micturition. 

104.  "When  Local  Boards  are  in  doubt  concerning  the  pli7/sical  fitness 
of  registrants  who  present  defects  of  the  genito-urinary  apparatus,  they 
shall  refer  them  to  the  Medical  Advisory  Boards,  or  to  a  member  or  mem- 
bers thereof. 

"  105.  When  it  is  deemed  necessary,  Local  Boards  and  Medical  Advisory 
Boards  should  take  advantage  of  cystoscopy  and  X-ray  examination  to 
verify  diagnosis  of  defects  of  the  genito-urinary  organs. 

103.  Physicians  of  Local  Boards  and  Medical  Advisory  Boards  should 
advise  and  aid  registrants  who  suffer  from  gonorrhea,  syphilis,  and 
chancroid  and  temporary  remediable  defects  of  the  skin  to  secure  proper 
treatment  pending  induction. 

XVI.  MENTAL  AND  NERVOUS  DISEASES. 

107.  Eegistrants  who  on  examination  show  the  following  conditions 
shall  be  unconditionally  accepted  for  general  military  service : 

(a)  A  normal  nervous  S3^stem. 

(5)  Who  appear  to  have  normal  understanding,  whose  speech  can 
be  understood,  who  have  no  definite  signs  of  organic  disease  of  the 
brain,  spinal  cord,  or  peripheral  nerves,  and  who  are  otherwise 
mentall}'  and  physicall}-  fit. 

{c)  Hysterical  paralysis  or  hj^sterical  stigmata  and  local  mus- 
cular spasms  which  do  not  cause  mental  or  physical  defects  disquali- 
fying for  general  military  service. 

{(I)  Muscular  tremors  of  moderate  degree. 

108.  Registrants  who  on  examination  are  found  to  suffer  from  the 
following  condition,  who  frre  otherwise  mentallj''  and  physically  fit, 
may  be  conditionally  accepted  for  general  military  service  in  the  de- 
ferred remediable  group: 

{a)  Drug  addiction,  including  the  habitual  use  of  opium  and  its 
derivatives  and  cocaine. 

109.  Registrants  who  on  examination  are  found  to  suffer  from  the 
following  defects  of  the  nervous  system,  who  are  otherwise  men- 
tally and  physically  fit,  may  be  accepted  for  special  and  limited  mili- 
tary service : 

(a)  Stuttering  and  stammering  of  a  degree  disqualifying  for  gen- 
eral military  service  but  wdiich  has  not  prevented  from  successfully 
following  a  useful  vocation  in  civil  life. 

(5)  Hysterical  paralysis  or  hysterical  stigmata  of  a  degree  dis- 
qualifying for  general  military  service  but  not  of  a  character  to 
prevent  the  registrants  from  successfully  following  a  useful  vocation 
in  civil  life. 


O' 


(c)  Tremors  of  such  marked  degree  that  they  disqualify  for  gen- 
eral military  service  but  have  not  prevented  tlie  registrants  from  fol- 
lowing a  useful  vocation  in  civil  life. 

110.  Registrants  who  on  examination  are  found  (o  suffer  from  the 
following  defects  shall  be  unconditionally  rejected  for  all  military 
service : 

(a)  Insanity. 

(b)  Epileps}^ 
(e)  Idiocy. 

(d)  Imbecility. 

(e)  Moron.     (See  Section  115.) 
(/)   Chronic  alcoholism. 

(g)  Stuttering  or  stannnering  to  such  a  degree  that  the  registrant 
is  unable  to  express  himself  clearly  or  to  repeat  commands  or  to  de- 
mand the  countersign. 

(h)   Constitutional  psychopathic  state. 

(i)  Chronic  essential  chorea. 

(j)  Tabes  (locomotor  ataxia). 

(k)  Cerebrospinal  syphilid. 

(l)  Multiple  sclerosis. 

(m)  Paraplegia. 

(n)  S,yringoniyelia. 

(g)  Muscular  atrophies  and  dystrophies  wliich  are  obviously  dis- 
qualifying. 

(p)  Hysterical  paralysis  or  hysterical  stigmata  so  serious  that 
these  defects  are  disqualifying  for  military  service. 

(q)  Neuritis  which  is  not  temporary  in  character  and  which  has 
progressed  to  such  a  degree  as  to  prevent  the  registrant  from  follow- 
ing a  useful  vocation  in  civil  life. 

111.  Ail  registrants  who  suffer  from  defects  involving  the  mental  or 
nervous  system  concerning:  v/hich  the  Local  Boards  are  in  doubt  should  be 
referred  to  the  Medical  Advisory  Boards,  or  to  a  member  or  members 
thereof. 

112.  The  examiners  may  base  their  decisions  as  to  mental  and 
nervous  defects  upon  the  following  brief  description  of  some  dis- 
qualifying defects : 

113.  Insanity. — All  registrants  should  be  considered  insane  who 
are  committed  or  v>ho  have  been  committed  to  a  licensed  public  or 
private  institution  for  the  care  of  the  insane.  The  examiners  may 
require  proof  in  the  form  of  verified  records  of  commitment  by  the 
proper  State  authorities  to  verif  \'  the  statements  of  the  registrants. 

114.  Epilepsy. — The  registrant  shall  not  be  considered  an  epileptic 
unless  the  claim  is  substantiated  by  characteristic  scars  on  the  tongue, 
face,  or  head,  or  if  the  examiner  is  in  doubt,  by  properly  certified 
proof  o]:)tained  by  the  registrant  or  by  the  Government  Appeal  Agent, 
which  shall  be  filed  with  Form  1010. 


115.  Moron. — An  in(ii^'idllal  whose  mental  development  is  that 
of  a  child  not  over  eight  jears  of  age,  as  measured  by  the  Binet-Simon 
test,  is  not  competent  to  learn  nor  to  perform  th^  duties  required  of 
a  soldier. 

118.  Idiocy.— X  registrant  shall  be  declared  an  idiot  who  has  been 
so  defective  in  mind  from  birth  or  from  early  age  that  he  is  unable 
to  guard  himself  against  common  physical  danger. 

117.  Imbecility. — A  registrant  shall  be  declared  an  imbecile  who 
has  been  so  defective  in  mind  from  birth  or  early  age  as  to  be  in- 
capable of  earning  a  livelihood  but  at  the  same  time  is  able  to 
guard  himself  against  common  physical  danger. 

118.  Chronic  alcoholism. — A  registrant  shall  be  declared  a  suf- 
ferer from  chronic  alcoholism  v\hen  he  presents  a  majority  of  the 
following  symptoms  and  signs:  Suliused  e^'es;  prominent  super- 
ficial blood  vessels  of  nose  and  cheek ;  flabby,  bloated  face :  red  or 
pale  purplish  discoloration  of  mucous  membrane  of  the  phar^mx 
and  soft  palate;  muscular  tremor  of  the  protruded  tongue  and 
extended  fingers ;  tremulous  handwriting. 

The  history  or  evidence  presented  that  the  registrant  has  been 
frequently  and  grossly  intoxicated  is  not  of  itself  sufficient  proof 
lor  the  diagnosis  of  chronic  alcoholism, 

CLIMCAL  J'OK-"\IS  or  IXSAMTV. 

119.  Dementia  precox. — Look  for  indifference,  apathy,  withdrawal 
from  environment,  ideas  of  reference  and  persecution,  feelings  of 
the  mind  being  tampered  with,  of  thought  being  controlled  by 
hypnotic,  spiritualistic,  or  other  mysterious  agencies,  hallucinations 
of  hearing,  bodily  hallucinations,  frequently  of  electrical  or  sexual 
character;  meaningless  smiles;  in  general,  inappropriate  emotional 
reaction  and  lack  of  connectedness  in  conversation.  There  may  be 
sudden  emotional  or  motor  outbursts.  The  history  of  family  life 
and  of  scliool,  vocational,  and  personal  career  will  usually  show 
erratic  and  more  or  less  irrational  conduct. 

120.  3Imuc-depressive  insanity. — Look  for  mild  depression,  with  or 
without  feeling  or  inadequacy,  or  mild  manic  states  with  exhilara- 
tion, talkativeness,  and  overactivity'. 

ORGANIC  DISEASES  OF  THE  BRAIN,  SPINAL  CORD,  AND 

PERIPHERAL  NERVES. 

121.  Paresis  (general  paralysis). — The  diagnosis  of  paresis  may 
be  made  wheji  at  the  examination  of  the  registrant  a  majority  of 
the  following  signs  and  symptoms  are  demonstrated:  Argyll-Rol)- 
ertson  pupil  or  pupils,  facial  tremor,  speech  defect  in  test  phrase?;, 
and  in  the  slurring  and  distortion  of  words  in  conversation;  writing 


39 

defects  consisting  of  omi.^sions  and  the  distortion  of  words,  Apa- 
tlietic  or  depressed  or  euphoric  mood.  The^e  registrants  may  show 
memory  loss,  or  discrepancies  in  rehiting  facts  of  life;  the  knee  jerks 
may  be  plus,  minus,  or  normal.  v; 

122.  Tabes  {locomotor  ataxia). — The  diagnosis  of  this  disease 
should  be  made  when,  at  the  examination  of  the  registrant,  several 
of  the  following  signs  and  symptoms  are  present :  Argyll-Robertson 
pupil  or  pupils;  absent  knee  jerk;  Eomberg  symptom;  ataxia  of 
hands  or  legs  (especially  when  the  eyes  are  closed) ;  hypotonia;  and 
anesthetic  areas  of  the  skin.  The  history  of  the  locomotor  ataxia  is 
usually  that  of  slo\v  progression,  of  failing  sexual  power,  and  pains 
in  the  legs  or  back  which  are  often  described  as  rheumatism.  j 

123.  C erehrO'S pinal  syphilis. — The  prominent  diagnostic  signs  and 
symptoms  are  headache,  varying  deep  and  superficial  reflexes,  jnipil-^  | 
lary  changes,  ptosis,  ocular  palsies,  facial  weakness;  the  mental  state 
is  normal,  dull,  or  apathetic.     Comparative  motor  weakness  may;  j 
occur  of  one  side  of  the  body  or  of  one  extremity. 

124.  Multiple  sclerosis. — The  diagnosis  of  this  disease  rests  upon 
the  following  signs  and  symptoms:  Intention  tremor,  nystagmus, 
absent  abdominal  reflexes,  increased  tendon  reflexes,  and  scanning" 
speech ;  in  cases  of  this  kind  the  history  obtained  is  not  characteristic, 
but  sometimes  there  may  be  a  history  of  urinary  disturbance. 

125.  Paraplegia. — The  diagnosis  of  paraplegia  from  whatever 
cauSe  will  rest  upon  weakness  of  the  lower  extremities,  associated 
with  lost  or  increased  knee  jerk,  Babinski  reflex,  or  disturbance  of 
the  sphincters  of  the  rectum  and  bladder,  with  or  without  girdle 
sensations.  Sensory  disturbance  of  the  skin  may  or  vcio^y  not  bo 
present.    Muscle  sensibility  may  be  diminished. 

126.  Syringomyelia, — Syringomyelia  is  usually  evidenced  by  more 
or  less  loss  qi  power  and  atrophy  of  groups  of  muscles  of  one  or  more 
extremities;  disturbance  of  the  sensations  of  the  skin,  more  especially 
in  the  form  of  analgesias,  and  diminution  of  the  temperature  sense ; 
if  in  the  upper  dorsal  cord,  often  associated  with  stooj^ed  shoulder 
posture;  if  in  the  lower  dorsal,  with  weakness  in  one  or  both  lower 
extremities. 

12T.  Muscular  atrophies  and  dystrophies. — The  signs  and  symptoms 
of  muscular  atrophies  and  dystrophies  are:  Atrophies  of  the  small 
muscles  of  the  hand  and  of  the  muscle  groups  of  the  shoulder; 
fibrillary  twitchings.  The  history  of  these  defects  rarely  furnishes 
reliable  data,  although  it  will  usually  be  found  that  the  registrant 
has  shown  evidences  of  awkwardness.  There  is  never  a  history  of 
pain  in  the  affected  muscles. 

128.  Multiple  neuritis. — The  chief  manifestations  are  more  or  less 
pain  in  tlie  course  of  the  affected  nerves,  with  tenderness  over  the 
trunks  of  the  nerves  and  of  the  muscles  supplied  by  them:   les- 


40 

sened  muscular  power  of  varying  degrees;  more  or  less  atrophy  of 
muscles,  with  or  without  contraction  and  evidences  of  trophic 
changes  of  the  skin.  The  reflexes,  deep  and  superficial,  may  be 
diminished  or  absent ;  the  sphincters  are  not  involved. 

Existent  organic  nervous  disease  should  always  exclude. 

For  example,  neuritis,  of  one  or  many  nerves,  while  susceptible 
of  recovery  without  resultant  defect,  is  none  the  less  a  cause  for 
rejection  as  long  as  it  exists. 

129.  Certain  after  effects  of  organic  nervous  disease  need  not  be 
causes  for  rejection  provided  (1)  that  the  disease  is  no  longer  opera- 
tive and  is  not  likely  to  recur,  (2)  that  the  effect  left  by  it  does  not 
prevent  a  satisfactory  fulfillment  of  military  duties.  Examples  of 
such  conditions  are  paralysis  of  a  few  unimportant  muscles  following 
poliomyelitis,  slight  unilateral  hypertonicity  as  a  result  of  an  infan- 
tile hemiplegia  in  a  man  now  robust,  and  various  traumatic  condi- 
tions.   (See  Sections  72  (c)  and  74  (o).) 

XVII.  LUNGS  AND  CHEST  WALL. 

130.  Registi^nts  who  on  examination  are  found  to  present  the  fol- 
lov/ing  conditions  shall  be  unconditionally  accepted  for  general  mili- 
tary service: 

(a)  Normal  lungs. 
(h)  Normal  pleura. 

(c)  Normal  bronchi. 

(d)  Acute  bronchitis. 

(e)  Hay  fever. 

(/)  Scars  of  operation  of  empyema  which  ha^'e  been  healed  for 
one  year  or  longer  when  the  function  of  the  lung  is  good. 

{(/)  Acute  pleurisy  with  effusion,  provided  the  acceptance  of  the 
registrant  shall  be  temporarily  dcla^'ed  for  observation  and  re- 
examination and  there  is  finally  established  evidence  satisfactory  to 
the  examiners  that  the  pleurisy  and  the  effusion  have  entirely  disap- 
peared.    (See  Sec.  133.) 

(h)  Fracture  of  the  rib  or  ribs,  provided  the  acceptance  of  the 
registrant  is  temporarily  deferred  until  a  final  examination  shows 
recovery  with  or  without  deformit}'^,  and  provided  the  deformity, 
if  any,  does  not  interfere  v;ith  respiratory  movements. 

(/')  Benign  tumors  of  the  breast  or  of  the  chest  wall,  provided  the 
enlargement  does  not  interfere  with  the  wearing  of  a  uniform  or 
militar}^  equipment. 

{])  Small,  palpable  lymph  glands  of  the  axilla  which  apparently 
do  not  interfere  v/ith  the  general  health. 

(k)  Syphilitic  periostitis  of  rib  or  ribs,  sternum  or  clavicle. 


41 

131.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing remediable  defects,  who  are  otheiwise  mentally  and  physically 
fit,  may  be  conditionally  accepted  for  general  military  service  in  the 
deferred  remediable  gi'oup : 

{a)  Typhoid  i)eriostitis  of  rib  or  ribi5. 

(b)  Tumor  of  the  breast  or  of  the  chest  wall  wnth  such  enlargement 
as  to  intei-fere  wath  the  wearing  of  a  uniform  or  military  equipment. 

132.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing defects  shall  be  unconditionally  rejected  for  all  military  service : 

{a)   Tuberculosis  of  the  lungs. 

{h)  Tuberculous  pleurisy. 
■     (c)   Unhealed  sinuses  of  the  chest  wall  following  operation  for 
empyema. 

{d)  Chronic  bronchitis  with  emphysema. 

(e)  Chronic  asthma  associated  with  chronic  bronchitis  and  em- 
physema. 

(/)   Fetid  bronchitis. 

{g)  Bronchiectasis. 

(A)  Syphilis  of  the  lung. 

(/)    Actinom3^cosis. 

{])  Hydatid  cysts. 

{k)  Restricted  respiratory  movements  of  chest  due  to  deformity 
of  the  chest  as  a  result  of  fracture  of  ribs  or  other  injuries. 

(?)    Tuberculosis  of  the  ribs. 

{m)  Cancer. 

133.  When  Local  Boards  are  in  doubt  concerning  the  physical  condi- 
tion of  registrants  who  present  defects  of  the  lungs,  pleura,  or  bronchi, 
they  should  be  referred  to  the  Medical  Advisory  Boards,  or  to  a  member 
or  members  thereof. 

134.  Inasmuch  as  pleurisy,  with  or  without  effusion,  is  a  very  fre- 
quent incidence  of  early  tuberculosis,  physicians  of  Local  Boards  and 
Medical  Advisory  Boards  should  examine  with  the  greatest  care  regis- 
trants who  have  apparently  recovered  from  pleurisy. 

135.  The  following  information  concerning  metliods  of  examina- 
tion of  the  lungs  and  the  interpretation  of  the  findings  are  pre- 
sented for  the  guidance  of  examiners : 

136.  The  examiners  should  be  extremely  careful  to  reject  regis- 
trants with  manifest  pulmonary  tuberculosis  for  all  military  service 
and  to  accept  for  military  service  registrants  who  allege  tuberculosis 
as  a  ground  for  exemption  or  discharge  on  the  basis  of  insufficient  or 
incorrectly  interpreted  signs  and  symptoms. 

Men  who  desire  to  serve  their  country  may  conceal,  from  patriotic 
motives,  symptoms  of  tuberculosis  which  they  know  or  suspect  to 
exist.  Some  tuberculous  patients  will  seek  enlistment  with  a  view 
to  obtaining  treatment  and  a  pension.  Some  soldiers  who  have 
volunteered  may  repent  their  action  and  allege  symptoms  of  tuber- 


42 

culosis  with  a  view  to  securing  discharge.  Some  registrants  may  bo 
expected  to  claim  the  existence  of  tuberculosis  as  a  ground  for  exemp- 
tion, and  may  fortify  their  claims  by  certificates  of  physicians  and 
by  radiograi)hs.  Such  certificates,  etc.,  must  not  be  acceptx'd.  but 
draft  examiners  must  satisfy  themselves  as  to  Uie  physical  qualifica- 
tions of  registrants  by  their  i)ersonal  examinations.  There  will  prob- 
ably be  many  cases  in  which  pulmonary  tuberculosis  will  have  been 
diagnosticated  on  the  ground  of  sul>jective  symptoms  and  of  physi- 
cal signs  which  are  normal  or  indicate  unimportant  and  healed 
lesions  of  some  kind. 

It  is  necessary,  therefore,  that  conclusions  of  the  examiner  shall 
be  based  only  on  physical  signs,  sputum  examinations,  and  radio- 
graphs. Statx^ments  of  the  subject  as  to  symptoms  will  not  be 
accepted  as  proof  of  the  existence  of  tuberculosis  unless  supported 
by  objective  evidence. 

It  is  the>  duty  of  examiners  to  protect  the  interests  of  the  Government 
by  preventing  men  from  entering  the  service  who  have  manifest  tuber- 
culosis. It  is  equally  their  duty  to  prevent  the  escape  from  service  on 
the  ground  of  tuberculosis  of  men  who  present  slight  or  doubtful  devia- 
tions from  the  normal.  It  is  therefore  necessary  to  insist  that  recom- 
nipcndations  for  dischargQ'  for  tuberculosis  of  otherwise  apparently 
healtliy  and  A'igorous  men  shall  be  based  Only  upon  the  presence  of 
(hiiiuito  and  i)laiidy  marked  signs  of  pulmonary  lesions. 

137.  'Jlio  f(jllowing  signs  will  not  be  regarded  as  evidence  of  pul- 
monary disease  in  the  absence  of  other  signs  in  the  same  portion  of 
the lung^: 

(a)  SliglUly  liarsh  breathing,  .slightly  j^rolonged  expiration  over 
the  right  apex  above  the  clavicle  anteriorly  and  to  the  thii'd  dor.sal 
vertebra  posteriorly.    The  same  signs  at  the  extreme  apex  left  side. 

(6)  Same  signs  second  interspace  riglit  anteriorly  jiear  sternum 
(proximity  of  right  main  bn^ichus). 

(c)  Increa.sed  vocal  resonance,  slightly  harsh  breathing  inniiedi- 
ately  below  center  of  left  crlavicle. 

(d)  Fine  crepitations  over  sternum  heard  when  stetho.scope  touclies 
the  edge  of  that  bono. 

(e)  Clicks  heard  during  strong  respirsttion  or  aftei-  cough  in  the 
vicinity  of  the  sternocostal  articulations. 

(/)  The  so-called  atelectatic  n'des  at  the  apex  during  the  first 
inspiration  which  follows  a  deeper  breath  thim  iisiuil  or  a  cough. 

{(/)  Sounds  resembling  rales  at  base  of  lung  (uiargjnal  .sounds), 
especially  nuirked  in  right  axilla,  limited  to  insiuration. 

(A)  Similar  sounds  heard  at  apex  of  heart  on  cmigh  (lingula). 

(i)  Slightly  prolonged  expiration  at  left  ba.se  i:)osteriorly. 


43 

(j)  Very  slight  harshness  of  respiratory  sounds  Avith  prolonged 
expiration  in  the  lower  paravertebral  regions  of  both  lungs  posteri- 
orly, most  marked  at  about  angle  of  scapula,  disappearing  a  short 
distance  above  tliat  point,  equal  on  both  sides,  or  slightly  more 
marked  at  the  angle  on  one  side,  more  frequently  the  left. 

138.  The  apices. — The  attention  of  examiners  is  particularly  in- 
vited to  the  necessity  of  exercising  gi'eat  conservatism  in  their  in- 
terpretation of  physical  signs  over  the  apices.  Interpretation  of 
such  signs  as  indicating  active  tuberculosis  would  in  many  cases  do 
the  Government  great  injustice,  leading  to  the  exclusion  of  men 
who  are  fit  for  service. 

The  only  trustworthy  sign  of  active  apical  tuberculosis  is  the  presence 
of  persistent  moist  rales. 

139.  Indications  from  X-ray  negatives. — The  X  ray  shows  (1) 
tuberculous  disease  confined  to  region  of  hilus  in  deep  lung;  (2)  ex- 
tension upward  toward  apex  or  downward  and  outward  toward  base, 
confined  to  deep  lung;  (3)  a  fine  line  or  two  extending  to  apex  with 
or  Avithout  small  focus  or  foci  there — condition  not  determinable  by 
physical  signs;  (4)  clouding  of  apex  without  marked  lines  from 
hilus,  probably  largely  pleuritic;  (5)  well-marked  lines  extending  to 
superficies  of  apex,  usually,  but  not  necessarily,  with  foci  there — ■ 
lesion  accessible  to  physical  examination;  (6)  lines  extending  toward 
shoulder  as  well  as  apex — {a)  if  confined  to  deep  lung  ma}^  mean 
early  and  now  healed  exacerbation — ijj)  if  extending  to  superficies 
denote  larger  lesion  and  less  immunity  than  5;  (7)  more  or  less 
widely  dilfused  spots,  lines,  and  streaks  through  a  considerable  por- 
tion of  lower  lobe  approaching  peripherj^  of  lung,  with  few  or  no 
auscultatory  signs — deep  peribronchial  tuberculosis;  (8)  more  exten- 
sive streaked  opacities  involving  greater  part  of  one  or  both  lungs 
and  extending  to  periphery''  with  few  or  many  phj'sical  signs — fibro- 
caseous  tuberculosis,  fibrosis  preponderating  in  proportion  to  scanti- 
ness of  more  or  less  rounded  spots  or  dots. 

Conditions  as  shown  by  1,  2,  3,  4,  and  6  («)  are  not  causes  for 
rejection.  Cases  under  5  are  to  be  determined  by  physical  examina- 
tion.    Cases  under  6  {l>),  7,  and  8  are  to  be  rejected. 

XVIII.  HEART  AND  BLOOD  VESSELS. 

140.  The  following  procedure  should  govern  in  the  examination 
of  the  heart : 

(a)  Location  and  determination  of  character  of  apex  impulse. 

(h)  Auscultation  of  the  heart  .sounds  over  apex,  lower  sternum, 
and  second  and  third  interspaces  to  right  and  left  of  sternum,  noting 
accentuation  of  sounds  and  murmurs. 


44 

(c)  Inspection  of  root  of  neck  and  upper  thorax  and  percussion 
of  first  interspace  on  each  side  of  manubrium  for  evidence  of 
aneurysm. 

{d)  Comit  of  radial  pulse,  observation  of  its  rhythm,  and  palpa- 
tion of  radial  arteries  for  unusual  thickening  or  high  tension. 

(e)  Exercise  test:  Hopping  100  times  on  one  foot.  At  close  count 
heart  rate  with  stethoscope  over  apex,  listening  for  murmurs  and 
noting  how  long  tachycardia  and  unusual  dyspnea  persist.  After 
two  minutes  neither  should  be  marked.  Examiners  should  use  judg- 
ment and  discretion  in  applying  the  exercise  test  to  registrants  who, 
in  the  preliminary  examination,  present  evidence  of  incompetency 
of  the  heart.  Registrants  should  not  be  placed  in  jeopardy,  but  at 
the  same  time  the  exercise  test  is  an  important  factor  in  determining 
the  condition  of  the  heart. 

141.  Eegistrants  who  on  examination  show  the  following  condi- 
tions, who  are  otherwise  mentally  and  physically  fit,  shall  be  uncon- 
ditionally accepted  for  general  military  service : 

{a)  Normal  heart.  (A  heart  shall  be  considered  normal  when 
tlie  apex  impulse  is  within  the  left  nipple  line  and  not  below  the  fifth 
interspace,  not  heaving  in  character,  with  normal  sounds,  free  from 
murmurs,  absence  of  pulsation  or  dullness  above  the  base  of  the 
heart,  regular  pulse  of  normal  rate,  no  unusual  thickening  of  the 
arteries  or  evidence  of  high  blood  pressure,  and  a  normal  response  to 
the  exercise  test.) 

{h)  A  pulse  rate  of  100  or  over  which  is  not  persistent.  (A  pulse 
rate  of  100  or  over  may  be  temporary  and  due  to  a  recent  infection, 
such  as  typhoid  fever  or  local  infections  about  the  nose,  mouth,  and 
throat.) 

{c)  A  pulse  rate  of  50  or  under  which  is  proved  to  be  the  natural 
pulse  rate  of  the  registrant  or  to  be  temporary  or  due  to  the  use  of 
drugs. 

(<:/)  Sinus  irregularity.  (This  consists  in  a  quickening  of  the  pulse 
rate  during  inspiration  and  a  slowing  during  expiration  and  is  best 
recognized  with  the  registrant  recumbent  and  breathing  deeply.) 

{e)  Old  thrombophlebitis  of  one  extremity  unassociated  with  any 
evidence  of  persistence  of  the  cause  thereof  or  of  obstruction  in  the 
involved  vein  or  veins. 

142.  Eegistrants  who  on  examination  are  found  to  present  the 
following  defects,  if  otherwise  physically  fit,  may  be  accepted  for 
special  and  limited  military  service,  unless  the  degree  of  disability  is 
obviously  disqualifying. 

{a)   Intermittent  claudication. 
(?>)   Raynaud's  disease. 


45 

143.  Registrant  who  on  examination  are  found  to  present  the  fol- 
lowing defects  shall  be  unconditionally  rejected  for  all  military  service: 

(a)  Circulatory  failure  evidenced  by  definite  symptoms  such  as  a 
combination  of  breathlessness,  marked  cyanosis  or  edema. 

(h)  Hypertrophy  and  dilatation  of  the  heart  evidenced  by  dis- 
placement of  the  apex  impulse  to  the  left  of  the  nipple  line  or  below 
the  sixth  rib,  and  of  a  heaving  or  diffuse  character. 

(c)  A  persistent  heart  rate  of  100  or  over  when  this  is  proved  to 
be  persistent  in  the  recumbent  posture  and  on  observation  and 
reexamination  over  a  sufficient  period  of  time. 

(d)  A  persistent  pulse  rate  of  50  or  under  proved  te  be  due  to 
heart  block. 

(e)  Complete  irregularity  of  the  pulse  when  this  is  found  to  be 
due  to  auricular  fibrillation. 

(/)  Valvular  disease,  as  evidenced  by  characteristic  murmurs,  en- 
largement of  the  heart,  and  a  lack  of  the  normal  response  to  exercise. 

(g)  Arteriosclerosis  and  hypertension  evidenced  by  a  tense  pulse, 
persistent  systolic  blood  pressure  above  160  m.  m.,  accentuation  of  the 
aortic  second  sound  when  the  registrant  is  in  quiet  recumbenc3^ 

(h)  Thrombophlebitis  of  one  or  more  extremities  if  there  is  a 
persistence  of  the  thrombus  or  any  evidence  of  obstruction  of  circu- 
lation of  the  involved  vein  or  veins. 

(i)  Aneurysm  of  tlie  arch  of  the  aorta  or  of  any  other  large  vessel. 

144.  When  Local  Boards  are  in  doubt  concerning  the  physical  fitness 
of  registrants  who  suffer  from  defects  due  to  conditions  of  the  heart  or 
blood  vessels,  they  shall  refer  them  to  the  Medical  Advisory  Boards. 

145.  It  is  incumbent  upon  Local  Boards  and  Medical  Advisory 
Boards: 

(a)  To  accept  for  service  men  who  have  been  recommended  for  rejec- 
tion because  of  supposed  defects  which  do  not  indicate  disease  and  do  not 
impair  the  individual's  ability  to  undergo  severe  bodily  exertion. 

(7j)  To  exclude  from  active  service  in  the  Army  any  registrant  affected 
with  disease  of  the  heart  or  blood  vessels  which  impairs  his  ability  to 
undergo  severe  bodily  exertion. 

146.  Men  who  desire  to  sem^e  their  countrj^  may  from  patriotic 
motives  endeavor  to  conceal  a  known  valvular  lesion  which  has  given 
no  symptoms.  On  the  other  hand,  men  drafted  for  service  may 
allege  or  feign  symptoms  to  obtain  exemption.  Registrants  may  be 
expected  to  present  physicians'  certificates  to  substantiate  the  exist- 
ence of  valvular  disease.  Many  of  these  may  be  given  in  good  faith 
because  of  inadequate  knowledge  of  the  significance  of  certain  fre- 
quent murmurs.  Such 'certificates  will  not  be  accepted,  but  draft 
examiners  must  satisfy  themselves  by  their  personal  examinations 
as  to  the  physical  qualifications  of  registrants. 


46 

147.  It  is  necessary,  therefore,  that  the  conckisions  of  the  exammer 
shall  be  based  on  objective  evidence  in  the  widest  sense,  including 
both  physical  signs,  cardiac  rhythm,  measurement  of  the  blood  pres- 
sure, and  the  observed  effect  of  effort.  Nevertheless,  in  the  presence 
of  questionable  signs  or  symptoms,  the  history,  especially  of  past 
rheumatic  fever,  may  be  a  factor  in  the  final  decision.  No  statements 
of  the  subject,  however,  will  be  accepted  as  proof  of  the  existence  of 
a  cardio- vascular  defect,  unless  supported  by  objective  evidence. 

148.  Since  it  is  the  duty  of  examiners  to  protect  the  interests  of  the 
Government  by  preventing  men  from  entering  the  service  whose  circula- 
tory systems  may  be  expected  to  break  down  under  strain,  and  equally 
by  preventing  the  exemption  or  discharge  of  fit  subjects  because  of  unim- 
portant deviations  from  the  normal,  it  will  be  necessary  for  them  to 
exercise  every  care  in  the  interpretation  of  their  findings  and  to  bear  in 
mind  constantly  the  murmurs  and  other  departures  from  the  supposed 
normal  which  may  occur  in  perfectly  healthy  hearts. 

149.  Principles  of  interpretation  of  symftoTns  and  signs  referable 
to  the  heart. — The  following  principles  are  laid  down  for  the  guid- 
ance of  examiners  in  their  interpretation  of  abnormal  signs  and 
symptoms :  In  many  cases  the  interpretatidn  must  be  purely  individual 
and  based  on  the  cumulative  evidence  of  a  number  of  relatively 
slight  deviations  from  the  normal.  It  can  not  be  too  strongly  in- 
sisted on  that,  given  a  heart  of  normal  size  and  responding  nor- 
mally to  effort,  any  murmur  that  is  heard  should  be  considered  ac- 
cidental and  insignificant  unless  it  can  be  positively  demonstrated 
that  it  is  a  mitral  or  aortic  diastolic  murmur.  It  should  also  be 
constantly  borne  in  .mind  that  the  excitement  of  the  examination 
may  produce  violent  and  rapid  lieart  action,  often  associated  with 
a  transient  systolic  murmur,  which  conditions  may  erroneously  be 
attributed  to  the  effects  of  exertion.  They  will  usually  disappear 
promptly  in  the  recumbent  posture,  but  the  examiner  must  be 
shrewd  to  distinguish  the  excitable  individuals  and  take  measures  to 
eliminate  psychic  influences  from  the  test  so  far  as  possible. 

150.  Hypertrophy  and  dilatation  of  the  heart. — Impulse  to  the 
left  of  the  nipple  line  or  below  the  sixth  rib  and  of  heaving  char- 
acter is  cause  for  rejection.  Its  cause,  either  valvular  disease  or 
hypertension  in  the  majority  of  cases,  should  be  sought  for.  It 
should  not  be  made  a  primary  diagnosis  unless  careful  examination 
fails  to  reveal  a  cause. 

151.  Valvular  diseases. — Cardiac  murmurs  are  the  most  certain 
physical  signs  by  which  valvular  disease  may  be  recognized  and 
its  location  determined,  but  murmurs  are  very  frequent  in  the  ab- 
sence of  valvular  lesions  and  may  occur  in  perfectly  healthy  hearts, 
especially  under  the  influence  of  excitement   and  exertion.     Such 


47 

accidental  murmurs  are  always  systolic  in  time.  The  most  frequent 
of  these  are : 

(a)  Those  heard  at  the  apex  on  excitement,  especially  when  recum- 
bent. 

(h)  Those  heard  over  the  second  and  third  left  interspaces  during 
expiration,  disappearing  during  forced  inspiration.  These  are  par- 
ticularly common  in  men  with  flexible  chests,  who  can  produce 
extreme  forced  expiration  and  under  such  circumstances  maj^  be 
associated  with  definite  thrill. 

(c)  Systolic  accentuation  of  the  respiratory  murmur,  especiallj' 
on  inspiration,  heard  near  the  apex  or  over  the  back. 

Systolic  murmurs  as  described  in  subparagraphs  (a),  (6),  and  (c) 
are  not  indicative  of  defects  which  shall  disqualify  a  registrant  for 
general  military  service.' 

Systolic  murmurs  unassociated  with  enlargement  of  the  heart, 
alteration  of  the  first  sound,  accentuation  of  the  pulmonic  second 
sound,  or  abnormal  response  to  exercise  may  also  be  considered  as 
without  significance. 

152.  Other  systolic  murmurs  : 

(a)  Loud  systolic  murmurs,  audible  at  the  apex  and  in  the  left 
back,  if  associated  with  any  enlargement  of  the  heart,  with  snapping 
first  sound,  or  accentuation  of  the  pulmonic  second  sound,  constitute 
a  disqualifying  defect.     (See  Section  142  (/).) 

(5)  Systolic  murmurs  at  the  base,  except  as  specified  above,  espe- 
cially those  heard  in  the  second  right  intercostal  space,  require  more 
careful  scrutiny.  The}^  may  be  due  to  disease  of  the  aortic  valves. 
In  this  case  they  should  be  harsh,  conveyed  well  into  the  neck,  asso- 
ciated with  an  aortic  diastolic  murmur,  with  thrill,  or  w  ith  a  marked 
enfeeblement  of  the  aortic  second  sound.  They  are  more  often  due 
to  dilatation  of  the  aorta,  either  syphilitic  or  arteriosclerotic.  The 
other  signs  of  dilatation  should  then  be  sought — increased  dullness 
in  the  first  and  second  interspaces  to  either  side  of  the  manubrium, 
pulsation  in  this  area,  accentuation  of  the  aortic  second  sound.  In 
doubtful  cases  X-ray  examination  and  Wassermann  test  should  be 
made. 

153.  All  diastolic  murmurs,  at  apex  or  base,  including  presystolic 
murmurs,  shall  be  considered  evidence  of  valvular  disease.  The 
secondary  signs  should  be  sought  for,  viz,  enlargement  of  one  or 
both  sides  of  the  heart,  alteration  of  the  first  or  second  sound,  par- 
ticularly a  snapping  first  sound  and  accentuated  pulmonic  second 
sound  in  mitral  disease,  and  the  characteristic  pulse  of  aortic  insuffi- 
ciency. In  doubtful  cases  a  definite  history  of  rheumatic  fever  may 
be  given  w^eight.    The  exact  diagnosis  should  be  noted  on  the  record. 

154.  It  should  be  borne  in  mind  that  the  characteristic  presystolic 
murmur  in  certain  cases  of  mitral  stenosis  may  not  be  audible  during 


48 

rest.  It  is  therefore  important,  in  every  doubtful  case,  that  ausculta- 
tion be  made  immediately  after  the  exercise  test  and  in  both  the  erect 
and  the  recumbent  positions.  On  the  other  hand,  many  cases  of  tachy- 
cardia or  overacting  heart  present  physical  signs  very  suggestive  of 
mitral  stenosis  (sharp,  tapping  apex  beat,  sharp,  loud  first  sound, 
suggestion  of  apical  thrill,  etc.),  and  the  diagnosis  of  mitral  stenosis 
should  not  be  made  unless  a  distinct  presystolic  or  diastolic  murmur 
is  heard. 

XIX.  GENERAL. 

155.  Eegistrants  who  on  examination  are  found  to  present  the  fol- 
lowing condition  who  are  otherwise  mentally  and  physically  fit  shall 
be  unconditionally  accepted  for  general  military  service: 

(a)  Malaria,  acute  or  chronic. 

156.  Registrants  who  on  examination  are  found  to  present  the  fol- 
lowing defects  who  are  otherwise  mentally  and  physically  fit  may  be 
accepted  for  special  and  limited  military  service: 

{a)  Secondary  anemia,  due  to  hemorrhoids  or  any  other  remedi- 
able cause. 

(h)  Debility  due  to  recent  illness  or  to  employment  or  environment 
in  civil  life. 

((?)   Hemophilia. 

157.  Eegistrants  who  on  examination  are  found  to  suffer  from  the 
following  defects  shall  be  unconditionally  rejected  for  all  military 
service : 

(a)  Pellagra. 

(b)  Leukemia  of  all  clinical  types. 

(c)  Progressive  pernicious  anemia. 

(d)  Splenic  anemia. 

(e)  Cancer. 

(/)   Tuberculosis. 

(g)   Irremediable  metallic  poisoning. 

158.  Registrants  who  are  confined  from  injury  or  illness  to  their 
homes,  hospitals,  or  other  institutions  for  the  care  of  the  sick  shall  be 
examined  and  dealt  with  for  the  conditions  or  defects  found,  as  indicated 
in  Chapters  III  to  XXI,  inclusive. 

XX.  TEMPORARY  DEFECTS. 

159.  Registrants  who  are  confined  from  injury  or  illness  to  their 
homes  or  hospitals  or  other  institutions  for  the  care  of  the  sick  and 
are  found  to  suffer  from  temporary  defects  should  be  granted  a  rea- 
sonable delay  for  the  purpose  of  completing  the"  physical  exami- 
nation. 

160.  Eegistrants  who  are  reported  to  the  Local  Boards  or  to  the  Medi- 
cal Advisory  Boards  to  be  confined  to  their  homes  or  to  hospitals  or  in- 


49 

stitutions  for  the  care  of  the  sick  because  of  contagious,  communicable,  or 
reportable  diseases,  should  not  be  ordered  to  appear  before  Local  Boards 
or  Medical  Advisory  Boards  until  they  shall  have  been  discharged  by 
health  authorities  having  jurisdiction. 

161.  Eegistra,nts  who  are  convalescent  from  diphtheria  should  not  be 
inducted  into  military  service  until  three  negative  cultures  in  succession, 
at  intervals  of  three  days,  shall  have  been  obtained  from  the  throat. 

162.  When  Local  Boards  or  Medical  Advisory  Boards  are  unable  to 
command  the  facilities  for  making  throat  cultures  of  registrants  recover- 
ing from  diphtheria,  the  cultures  should  be  sent  by  mail  to  municipal 
laboratories  or  to  those  of  the  State  or  of  the  "United  States  Public 
Health  Service. 

XXI.  PURPOSELY  CAUSED  PHYSICAL  DEFECTS. 

163.  Whenever  it  shall  appear  to  a  Local  Board  or  to  a  Medical  Ad- 
visory Board  that  a  registrant  is  suffering  from  self-inflicted  or  purposely 
caused  physical  defects  which,  under  the  Standards  of  Physical  Exami- 
nations, would  render  him  disqualified  for  military  service  of  any  kind, 
a  full  statement  of  the  facts  and  of  the  condition  of  the  registrant  and  of 
the  Board's  recommendation  shall  be  prepared  and  attached  to  Form  1010, 
and  one  copy  of  Form  1010,  with  such  statement  attached,  shall  imme- 
diately be  sent  by  the  Local  Board  to  the  Adjutant  of  the  State  to  be 
transmitted  to  the  Provost  Marshal  General  in  order  that  the  case  may 
be  submitted  to  the  Surgeon  General  and  The  Adjutant  General  of  the 
Army  for  a  waiver  of  the  physical  defects,  if  recommended,  so  that  the 
registrant  may  be  compelled  to  render  militaiy  se-vice.  (See  Note  2, 
Sec.  128|  S.  S.  E.,  p.  63,  herein.) 

XXII.  NOTES  ON  MALINGERING. 

164.  Malingerers  may  be  divided  into  three  general  groups : 

(a)  Real  malingerers  with  nothing -the  matter  with  them,  who 
injure  themselves,  or  make  allegations  respecting  diseases  or  such 
conditions  as  drug  taking,  or  who  counterfeit  disease  with  full 
consciousness  and  responsibility;  all  for  the  purpose  of  evading 
military  service.     Many  of  these  have  been  coached. 

(b)  Psj^choneurotics,  who  are  natural  complainers  and  try  to  get 
out  of  every  disagreeable  thing  in  life.  Perhaps  only  partially 
conscious  of  the  nature  or  the  seriousness  of  what  they  do  and  only 
partly  responsible.  In  many  the  motives  are  not  persistent  and 
many  can  be  made  into  good  soldiers. 

(c)  Confirmed  psychoneurotics  with  long  history  of  nervous 
breakdowns  and  illnesses  who  behave  like  class  (a),  but  more  per- 
sistently, and  from  whom  not  much  can  be  expected  in  the  way  of 
reconstruction. 


50 

165.  The  detection  and  management  of  medical  cases  depends  tipon 
the  absence  of  positive  findings  in  one  who  presents  the  general  char- 
acteristics of  the  malingerer.  There  is  especial  need  for  the  physical 
examination  to  be  thorough  in  this  group.  Some  of  the  cardiac  cases 
at  first  regarded  as  malingerers  were  pronounced  later  by  the  cardio- 
vascular board  tiO  have  mitral  stenosis,  and  similarly  proper  tests 
have  shown  the  existence  of  gastric  ulcer  in  cases  which  were  under 
susx^icion  of  fraud.  The  estimation  of  the  reality  of  rheumatic  pains 
is  always  a  difficult  matter. 

166.  Suroical. — Under  this  are  included  old  scars  and  injuries  of 
the  bones,  fractures,  and  orthopedic  conditions. 

Note. — For  tlie  detection  of  malingerers,  in  tests  of  vision  and  hearing,  see 
paragraphs  27  to  34,  inclusive,  40,  and  41. 

167.  Artifically  created  conditions. — Men  shoot  or  cut  off  their  fin- 
gers or  toes,  practically  always  on  the  right  side,  to  disqualify  them- 
selves for  se]'vice.  Sometimes  they  put  their  hands  under  cars  for 
this  purpose.  Many  men  have  their  teeth  pulled  out.  Retention  of 
urine  is  simulated.  Egg  albumen  is  injected  into  the  bladder  or  put 
in  urine.  Glucose  is  added  to  urine.  Digitalis,  thyroid  gland  prepa- 
rations, and  strophanthus  are  taken  to  cause  disturbance  of  the  heart 
and  cantharides  to  cause  albuminuria.  The  skin  is  irritated  by  va- 
rious substances,  which  are  also  injected  under  it  to  create  abscesses. 
Various  substances  are  taken  to  Ijring  about  purging.  An  appear- 
ance of  hemoptysis  may  be  produced  by  adding  blood,  either  human 
or  that  of  animals,  to  the  sputa.  Sometimes  merely  coloring  mat- 
ter is  added.  Those  who  can  vomit  voluntarily  what  they  swal- 
low use  the  same  means  to  create  the  appearance  of  hematemesis. 
Similarly,  coloring  matters  may  be  added  to  the  stools.  Mechanical 
and  chemical  irritants  are  made  use  of  to  cause  inflammation  about 
practically  all  the  body  orifices.  Jaundice  may  be  simulated  by 
taking  picric  acid.  Crutches,  spectacles,  trusses,  strappings,  etc.,  are 
made  use  of  to  create  the  appearance  of  disability.     (See  sec.  165.) 

168.  Detection. — Wounds  are  rarely  self-inflicted  when  witnesses 
are  present,  consequently  it  is  almost  impossible  to  be  certain  of  the 
motive  behind  these.  Artificial  jaundice  is  to  be  recognized  by  the 
demonstration  of  picric  acid  in  the  urine. 

169.  Bed  ivettlng. — A  frequent  complaint  among  registrants  for 
military  service  but  not  a  cause  for  rejection. 

170.  The  surest  means  of  detecting  malingering  is  a  thorough  mider- 
standing  by  the  examiner  of  the  types  of  people  who  actually  do  it — 
and  the  way  they  behave.  It  is'only  in  the  feigned  diseases  of  the 
eye  and  ear  that  special  tests  are  required.  Observation  in  hospital 
is  necessary  in  difficult  cases.  The  vast  bulk  of  malingerers  are  those 
who  exaggerate  some  actual  defect,  and  the  problem  for  the  medical 


51 

examiner  is  to  decide  Avhether  the  defect  complained  of  is  sufficient 
cause  for  rejection  for  service.  Persons  of  intelligence  and  educa- 
tion have  more  difficultj'^  in  deceiving,  as  they  are  bound  to  express 
themselves  freely.  If  they  are  reticent  in  these  matters  they  arouse 
suspicion  by  their  reticence.  Those  who  talk  freely  may  be  counted 
on  to  say  things  at  variance  with  the  existence  of  the  disease  of 
which  they  complain. 

171.  Whenever  it  shall  appear  to  a  Local  Board  or  to  a  Medical  Ad- 
visory Board  that  a  registrant  is  endeavoring  to  escape  service  by  malin- 
gering, if  otherwise  mentally  and  physically  fit,  he  shall  be  inducted. 
A  full  statement  of  the  facts  shall  be  prepared  and  attached  to  each  copy 
of  Form  1010.     (See  Section  128^,  Note  3,  S.  S.  II.) 

NEKVOUS  AND  MENTAL. 

172.  Insanity. — Rarely  feigned  by  registrants  and  then  of  an  ex- 
tremely silly,  foolish  tj'pe.  In  cases  of  doubt,  hospital  observation  is 
necessary  with  verified  past  records.  Mental  defects  are  frequently 
feigned,  especially  b}^  illiterates.  Organic  diseases  of  the  central 
nervous  system  can  not  be  simulated. 

173.  Pain  and  hyi^eresthesia. — The  most  frequent  of  all  complaints. 
History  inconsistent,  ordinary  traces  of  suffering  absent.  Absence  of 
other  symptoms  usually  accompanj^ing  types  of  pain  complained  of. 
Absence  of  objective  evidence  of  localized  pains.  Xote  behavior 
when  the  registrant  believes  himself  unobserved. 

174.  Anesthesia. — Complaint  of  anesthesia  itself  creates  a  sus- 
picion of  malingering,  as  most  patients  with  anesthesia  are  ignorant 
of  it. 

175.  Epilepsy. — Men  w^ho  nave  sustained  head  injury  are  very  apt 
to  claim  fits.  These  complaints  may  be  in  reference  to  grand  mal  or 
petit  mal.  Petit  mal  attacks  are  spoken  of  as  fainting  attacks.  In 
grand  mal  attacks  there  is  loss  of  pupil  response  to  light,  loiee  jerks 
are  lost,  and  the  Babinsky  reflex  may  be  present. 

176.  Hysteria. — Not  feigned  in  itself,  but  its  existence  creates  con- 
fusion as  to  malingering.  The  question  to  be  decided  is  whether  the 
registrant  is  too  seriously  affected  with  the  neurosis  to  be  useful  as  a 
soldier.  Often,  even  when  the  physical  symptoms  are  most  pro- 
nounced (paralysis) ,  cure  is  still  possible, 

177.  Stif  hachs.—Si'i^  back  is  a  frequent  symptom  of  hysteria  in 
the  present  mobilization  among  selected  men.  In  cases  of  this  kind 
organic  disease  of  the  vertebra?  can  and  should  be  excluded,  if  neces- 
sary,  by  the  X  ray. 


APPENDIX. 

IMPORTANT  SECTIONS  OF  THE  SELECTIVE  SERVICE 
REGULATIONS  AND  RULES  OF  PROCEDURE  RELATING 
TO  PHYSICAL  EXAMINATIONS,  AND  PERTAINING  TO 
MEDICAL  EXAMINERS  AND  LOCAL,  DISTRICT,  AND 
MEDICAL  ADVISORY  BOARDS. 


Section  25.  Correspondence  rules  of  the  Office  of  the  Provost  Marshal  Gen- 
eral. 

Kule  A.  Except  as  specifically  provided  in  these  Regulations,  all 
communications  intended  for  the  Provost  Marshal  General  concern- 
ing the  execution  of  the  Selective  Service  Law  within  a  State  ema- 
nating from  individuals  within  the  State  or  from  Local  and  District 
Boards  or  other  officials  engaged  within  any  State  in  the  execution 
of  the  Selective  Service  Law.  must  be  directed  to  the  Adjutant  General 
of  the  State  for  reference  to  the  Provost  Marshal  General.  (See  sec.  31.) 
Correspondence  sent  in  violation  of  this  rule  to  the  office  of  the 
Provost  Marshal  General  will  be  returned  to  the  writer. 

Note  1. — War  Department  rules  governing  correspondence  require  that  all 
communications  be  forwarded  in  duplicate.     (Circular  Letter,  June  21,  1918.) 

Section   29.   Governor   to   District    State   and   Recommend   Appointment   of 
Members  of  Medical  Advisory  Boards. 

Each  State  shall  be  carefully  districted  vfith  due  regard  to  com- 
m-unication  and  hospital  facilities  for  the  erection  of  a  nuhiber  of 
Medical  Advisory  Boards  compacted  with  a  view  to  the  equitable  and 
practical  distribution  of  the  work  of  reexamination  as  provided 
herein  and  to  the  convenience  of  registrants  and  economy  to  the  Gov- 
ernment in  sending  registrants  before  such  boards.  Members  of 
Medical  Advisory  Boards  will  be  nominated  by  the  Governor  and 
appointed  by  the  President  in  accordance  with  instructions  to  be  here- 
after communicated  to  the-  Governors. 

A  member  of  the  Medical  Corps  of  the  Army  will  be  'assigned  as 
Medical  Aide  to  the  Governor  of  each  State.  Medical  Aides  will  be 
required  to  perform  the  following  functions : 

(a)   To  establish  close  relations  with  all  examining  physicians  of 

their  States. 

(52) 


53 

(5)  To  recommend  meetings  of  examining  physicians  for  the  pur- 
pose of  discussing  the  medical  problems  of  the  draft  and  for  the 
clearing  up  of  doubtful  points. 

(c)  To  visit  Local  and  Medical  Advisory  Boards;  to  observe  these 
at  work;  and  to  advise  with  examining  physicians. 

(d)  To  recommend  to  Governors  the  replacement  of  weak  exam- 
ining physicians;  to  arrange  for  additional  examining  physicians 
where  needed;  to  hasten  the  operations  of  physical  examinations 
where  such  are  unduly  slow  or  delayed. 

(e)  To  study  the  causes  of  rejections  at  camps,  with  a  view  to  the 
detection  of  inefficiency  in  the  physical  examination  of  registrants. 

(/)  To  perform  such  other  duties  in  connection  with  physical  ex- 
aminations of  drafted  men  as  may  be  required  of  them. 

Note  1. — Medical  Advisory  Boards  in  each  State  should  be  designated  by  num- 
bers (consecutively,  with  no  use  of  a  general  number  and  letters  for  divisions  of 
counties  and  cities).  Each  Board  should  be  notified  of  the  number  assigned  it 
and  should  be  required  to  use  this  number  designation  on  all  vouchers  and  re- 
ceipts sent  to  the  Office  of  the  Provost  Marshal  General.  (Circular  Letter  April 
18,  1918.) 

Note  2. — Appointments  to  and  removals  from  Medical  Advisory  Boards  can 
not  be  made  without  reference  to  the  President  through  the  Office  of  the  Provost 
Marshal  Genel-al.  The  Regulations  require  members  of  said  Boards  to  be  nomi- 
nated by  the  governor  and  appointed  by  the  President.  (Circular  Letter  April 
18,  1918.) 

Note  3. — The  Medical  Ait4e  to  the  Governor  should  be  the  instrument  of  direct 
communication  between  the  Governor  or  his  adjutant  general  and  the  Local 
Boards  and  Medical  Advisory  Boards  in  all  matters  concerning  questions  re- 
lating to  that  part  of  the  Selective  Service  Regulations  which  pertains  to  the 
physical  examinations  of  registrants.     (Circ.  Letter  May  8,  1918.) 

Note  4. — Class  1  registrants  who  are  physically  disqualified  for  general  mili- 
tary service  but  qualified  for  limited  military  service  and  also  specially  quali- 
fied for  such  clerical  and  administrative  work  may  be  Inducted  Into  service 
either  as  privates  or  in  noncommissioned  grades  for  clerical  and  administrative 
work  at  States  Headquarters  and  the  Local,  District,  and  Medical  Advisory 
Boards,  such  induction  to  take  place  under  rules  and  regulations  issued  for  that 
purpose.     (Telegram  P,-2682,  August  10,  1918,  and  Circ.  Letter  August  20.  1018.) 

Note  5. — Officers  of  the  Medical  Corps  ordered  to  report  as  Medical  Aides  to 
Governors  are  assigned  to  duty  subject  to  the  orders  of  Governors  to  whom 
they  should  Report  for  instruction.  Such  officers  will  be  governed  solely  by 
instructions  from  Governors  and  Adjutants  General  concerning  all  matters  con- 
nected with  Medical  Advisory  Boards.     (Telegram  A-lOO,  December  4,  1917.) 

Note  6. — Draft  Executives  will  supply  Medical  Aides  with  copies  of  all  modi- 
fications of  regulations  and  with  rules  governing  physical  examinations. 

Section  33.  Status  of  members  of  Local  and  District  Boards. 

Section  6  of  the  Selective  Service  Law  provides  that : 

*     *     *     All  persons  designated  or  appointed  under  regulations  prescribed  by 

the  President,  whether  such  appointments  are  made  by  the  President  himself  or 

by  the  governor  or  other  officer  of  any  State  or  Territory  to  perform  any  duty 

in  the  execution  of  this  Act,  are  hereby  required  to  perform  such  duty  as  the 


54 

President  shall  order  or  direct,  and  all  such  officers  and  agents  and  persons 
so  designated  or  appointed  shall  hereby  have  full  authority  for  all  acts  done  by 
them  in  the  execution  of  this  Act  by  the  direction  of  the  President.  *  *  * 
Any  person  charged  as  herein  provided  with  the  duty  of  carrying  into  effect  any 
of  the  provisions  of  this  Act  or  the  regulations  made  or  directions  given  there- 
under who  shall  fail  or«ieglect  to  perform  such  duty  *  *  *  or  who,  in  any 
manner,  shall  fail  or  neglect  fully  to  perform  any  duty  required  of  him  in  the 
execution  of  this  Act,  shall,  if  not  subject  to  military  law,  be  guilty  of  a  misde- 
meanor, and  upon  conviction  in  the  District  Court  of  the  United  States  having 
jurisdiction  thereof  be  punished  by  imprisonment  for  not  more  than  one  year, 
or,  if  subject  to  military  law,  shall  be  tried  by  court-martial  and  suffer  such 
punishment  as  a  court-martial  may  direct. 

Under  this  autliority  members  of  boards  are  as  effectively  drafted  for 
this  duty  as  are  registrants  who  are  selected  for  military  service  and  as 
such  are  entitled  and  should  be  given  deferred  classification  whenever 
certified  by  the  Governor  of  the  State  as  necessary  in  the  administra- 
tion of  the  Selective  Service  Law.  Appointments  and  changes  in 
membersliip  of  boards  will  be  made  by  the  President  upon  the 
recommendation  of  the  Governor.  Applications  for  relief  from  such 
appointments  should  be  made  to  the  Governor,  .  who  should  in- 
vestigate the  circumstances  and  recommend  relief  only  in  cases  in- 
volving hardship.  Applications  for  such  relief  will  be  considered 
only  when  submitted  through  the  Governor.  The  telegraph  should 
be  used  in  making  these  recommendations  only  in  cases  whose  urgency 
seems  to  justify  the  additional  expense. 

Note  1. — Responding  to  a  request  that  the  commissioning  of  medical  members 
of  Draft  Boards  be  discontinued  for  the  present,  except  in  instances  where  the 
Provost  Marshal  General  consents,  the  Surgeon  General  stated  that  every  elfort 
would  be  made  to  carry  out  the  wishes  of  the  Provost  Marshal  General,  and 
that  local  examiners  for  the  Department  of  War  would  be  requested  in  for- 
warding the  papers  of 'applicants  for  appointment  in  the  Medical  Corps  to 
indicate  whether  or  not  the  applicant  is  a  member  of  a  Local  Board.  (Ch-cular 
Letter,  August  23,  1918.) 

Section  42.  Additional  examining  physicians. 

In  addition  to  the  licensed  x^hysician  wdio  is  a  member  of  the  board 
or  if  no  licensed  physician  is  a  member  of  tlie  board,  the  Governor 
or  the  Local  Board  shall  designate  and  appoint  additional  examining 
physicians,  subject  to  removal  by  the  Governor  at  his  pleasure. 

It  shall  be  the  duty  of  persons  thus  designated  to  act  as  examin- 
ing physicians  of  the  Local  Board  for  which  they  are  designated, 
and  they  may  be  compensated  at  rates  hereinafter  prescribed.  (See 
sec.  196.)  In  addit-ion  to  the  number  of  physicians  that  may  be 
thus  designated  and  compensated  under  the  above  authority,  volun- 
teer physicians  in  any  convenient  number  may  be  utilized  for 'the  ex- 
amination of  registrants  upon  appointment  as  aforesaid. 

Examining  physicians  (unless  actually  appointed  by  the  President 
as  members  of.  boards)  are  not  to  be  considered  as  members  of  such 


55 

boards.  They  should  take  the  oath  prescribed  in  section  14  of  these 
regulations.  They  shall  have  no  vote  on  any  question  to  be  decided 
by  said  board.  (See  sees.  122,  12i.)  Their  report  on  the  physical 
examination  of  a  registrant  is  advisory  only. 

Note  1. — The  services  of  volunteer  dentists  to  aid  in  pliysical  examination 
of  registrants  by  Local  Boards  may  be  utilized,  but  tliey  are  not  members  of 
Local  Boards  and  have  no  vote.     ( See  Form  75. ) 

Section  43.  Clerical  Assistants  for  State  Headquarters  and  for  District,  Local, 

and  Medical  Advisory  Boards. 

(a)  When  authorized  by  the  Governor  on  and  after  September  1, 
1918,  as  prescribed  in  section  198  hereof,  there  may  be  employed  the 
necessary  clerks  for  State  Headquarters,  District  Boards,  Local 
Boards,  and  Medical  Advisory  Boards :  Provided,  That  no  clerk  shall 
be  paid  at  a  rate  in  excess  of  that  fixed  for  clerks  of  Local  Boards 
in  paragraph  (c)  of  this  section  without  specific  authority  of  the 
Provost  Marshal  General  in  each  case.  (For  entire  section,  see 
S.  S.  R.,  second  edition.) 

Section  44.  Medical  Advisory  Boards. 

There  have  been  j)rovided  in  the  various  counties,  cities,  and  other 
localities  throughout  the  United  States,  Medical  Advisory  Boards, 
who  will  examine  registrants  sent  to  them  by  Local  JBoards  or  State 
Adjutants  General  for  examination,  and  will  advise  such  Local 
Boards  or  State  Adjutants  General  concerning  the  physical  condi- 
tion of  such  registrants.     (See  sees.  123  and  182.) 

Note  1. — The  personnel  of  the  Medical  Advisory  Boards  should  be  kept  at  all 
times  as  full  as  efficiency  demands.  Members  of  these  Boards  who  hold  com- 
missions in  the  Rledical  Corps,  when  asigned  by  the  Surgeon  General  to  active 
duty,  automatically  cease  to  be  members  of  the  Boards.  Vacancies  on  the 
Boards  thus  created  may  be  filled  as  provided  in  section  29,  supra. 

Note  2. — In  those  States  and  localities  where  it  is  impossible  to  organize  an 
Advisory  Board  with  a  complete  personnel  of  qualified  specialists  it  is  not  ex- 
pected that  the  Advisory  Board  will  be  able  to  carry  out  the  complete  directions 
for  the  physical  examination  of  those  registrants  who  require  it.  In  this  emer- 
gency the  Medical  Aid  to  the  Governor,  with  the  latter's  authorization,  should 
make  provision,  if  possible,  for  the  registrant  to  be  examined  by  competent 
specialists  who  may  not  be  members  of  Advisory  Boards.  The  Advisory  Boards 
should,  whenever  practicable,  examine  registrants  at  the  established  head- 
quarters of  the  Board,  which  by  preference  should  be  a  general  hospital.  In 
certain  emergencies  the  registrant  may  be  sent  elsewhere  for  special  examina- 
tion, such  as  taking  a  roentgenogram,  eye  and  ear  tests,  etc. 

Note  3. — A  dentist  should  be  appointed  as  a  member  of  every  Medical  Ad- 
visory Board  wherever  possible.  Membership  of  Medical  Advisory  Boards  is 
not  limited  as  to  number  and  dentists  may  be  added  to  Boards  already  ap- 
pointed.    (Telegram  A-189,  Dec.  5,  1917.) 

Section  46.  Duties  of  lawyers  and  physicians  generally. 

The  selection  and  classification  of  men  for  military  service  is  an 
undertaking  that  should  be  regarded  as  a  systematized  effort  of  the 


56 

citizenry  of  tlie  whole  Nation  organized  and  compacted  to  meet  the 
present  emergency.  Every  citizen  has  a  duty  to  give  his  best  en- 
deavor to  the  success  of  this  undertaking  according  to  his  qualifica- 
tions and  talents.  All  lawyers  and  physicians  should  regard  it  as 
their  duty  to  identify  themselves  with  the  Advisory  Boards  provided 
for  in  sections  44  and  45,  and  freely  and  without  compensation  to 
give  their  best  service  to  the  Nation.  It  is  inconsistent  with  this 
duty  for  lawyers  to  seek  clients  for  the  purpose  of  urging  and  advo- 
cating individual  cases  in  any  other  way  than  as  disinterested  and 
impartial  assistants  of  the  Selective  Service  System,^ 

Lawyers  and  physicians  w^ll  render  a  most  valuable  assistance  by 
giving  their  services  to  Local  Boards  and  to  the  Medical  Advisory 
Boards  provided  in  section  44  hereof.  They  should  be  scrupulously 
careful  in  making  affidavits  and  furnishing  other  proof  of  a  medical 
cha.racter  to  registrants  in  support  of  claims  of  physical  disqualifi- 
cation and  respecting  physical  condition  or  infirmities  of  dependents. 

Section  122.  Physical  examination 

Beginning  on  such  date  or  dates  as  the  Provost  Marshal  General 
shall  hereafter  fix  for  the  beginning  of  the  physical  examination  of 
all  or  any  number  or  proportion  of  registrants,  and  after  a  registrant 
has  been  placet!  in  Class  I  by  a  Local  Board  (regardless  of  any 
appeal)  the  Local  Board  shall  mail  to  the  last  known  address  of  any 
registrant  placed  in  Class  I  a  notice  (Form  1009,  p.  226,  sec.  281) 
to  appear  for  physical  examination  at  a  time  and  place  to  be  desig- 
nated in  said  notice  (which  time  shall  be  five  days  from  the  date  of 
the  mailing  of  the  notice,  unless  otherwise  ordered  by  the  Provost 
Marshal  General),  and  shall  enter  the  date  of  mailing  of  said  notice 
in  column  19  of  the  Classification  List. 

Upon  appearance  of  the  registrant  he  shall  be  examined  as  provided 
in  Part  VIII  hereof  and  in  Form  75,  and  the  date  of  his  examination 
shall  be  entered  in  column  20  of  the  Classification  List.  The  examin- 
ing physician  shall  immediately  enter  his  report  and  recommendation 
in  triplicate  on  the  report  of  physical  examination  (Form  1010,  p.  227, 
sec.  282). 

The  same  procedure  as  to  physical  examina^tion  provided  in  these 
regulations  for  registrants  in  Class  I  shall  also  apply  to  all  regis- 
trants who  have  been  placed  in  a  class  more  deferred  than  Class  I, 
so  soon  as  the  immediately  preceding  or  earlier  class  has  been  ex- 
hausted by  calls  into  the  military  service  and  not  before,  except  as 
provided  in  sections  128, 149,  and  150. 

Note  1. — Whether  the  examining  physician  of  the  Local  Board  is  in  doubt  or 
not  as  to  the  physical  qualification  of  a  registrant  for  military  service,  he  shall 
nevertheless  definitely  report  the  registrant  either  as  qualified  or  disqualified, 
and  if  he  is  in  doubt  as  to  such  qualification  or  disqualification,  he  may  request 

1  The  provisions  of  the  last  sentence  apply  with  equal  force  to  physicians. 


57 

to  liiive  the  registrant  sent  before  a  Medical  Advisory  Board  or  a  nieiijier  or 
members  thereof  a.s  prescribed  in  section  123. 

Note  2.— Registrants  io  Classes  II,  III,  and  IV  will  not  be  psyslcally  exam- 
ined except  upon  general  order  issued  by  the  Provost  Marshal  General,  ov  when 
special  call  is  made  for  the  induction  into  military  service  of  registrants  in  such 
classes,  imless  under  the  provisions  of  section  128. 

NpTE  3.— The  entry  by  the  registrant  on, the  Questionnaire  of  the  claim  for 
physical  disqualification  is  not  to  be  construed  as  a  clalnr  from  which  an  appeal 
lies  to  the  District  Board  on  account  of  the  refusal  of  the  Local  Board  to  classify 
the  registrant  in  Class  .5-G.  Appeals  from  classification  on  physical  grounds 
may  be  made  as  provided  in  sections  122  to  128,  inclusive,  and  not  otherwise. 
(Telegram  A-2142,  Jan.  3,  1918.) 

Note  4. — See  sections  141,  142,  and  143  for  provisions  relating  to  transfer  of 
physical  examination,  physical  examination  of  registrants  residing  abroad,  and 
physical  examination  of  mariners  actually  employed  on  the  Great  Lakes. 

.Section  123.  Sending  doubtful  cases  to  a  Medical  Advisory  Board. 

If  the  examining  physician  is  in  doubt  as  to  whether  the  registrant 
is  to  be  held  for  military  service,  or  if  the  Government  Appeal  Agent 
or  two  members'  of  the  Local  Board  are  dissatisfied  with  the  finding 

to 

of  the  examining  physician,  the  examining  physician.  Government 
Appeal  Agent,  or  members  of  the  Local  Board,  may  apply  to  the 
Local  Board  to  have  the  registrant  sent  before  the  nearest  IMedical 
Advisory  Board  or  any  member  or  members  thereof  (provided  in  sec- 
tions 29  and  44  hereof)  for  a.  further  examination.^  Such  application 
shall  be  made  by  entering  it  in  the  place  provided  in  Form  1010  (p. 
227) .  Thereupon  the  Local  Board  shall,  linless  it  decides  by  imanimons 
vote  that  the  case  is  one  in  which  there  is  no  room  for  reasonable 
doubt,  immediately  send  the  registrant  before  such  Medical  Advi.sorv 
Board,  or  some  member  or  members  thereof,  forwarding  to  the  Medi- 
cal Advisory  Board,  or  such  member  or  members  thereof,  the  examiu; 
ing  physicians  report  (Foriji  1010,  p.227)  in  triplicate  and,  where  nec- 
essary, furnishing  the  registrant  with  transportiition  and  meals  and 
lodging  tickets  for  the  time  during  which  he  will  be  before  such  Medi- 
cal Advisory  Board,  or  member  or  members  thereof,  in  no  case  to  ex- 
ceed three  days. 

If  the  registrant  is  held  to  be  physically  disqualified  by  the  examin- 
ing physician,  the  Local  Board  shall,  unless  it  decides  by  unanimous 
vote  that  the  disqualification  is  such  as  to  leave  no  room  for  reason- 
able doubt,  send  the  registrant  before  such  Medical  Advisory  Board, 
or  some  member  or  members  thereof,  in  the  manner  just  provided. 

Upon  reference  of  a  case  from  a  Local  Board  as  just  provided,  the 
Medical  Advisory  Board,  or  the  member  or  members  thereof,  to  whom 
such  registrant  has  been  sent,  shall  examine  the  registrant,  record  its 
or  their  findings  in  triplicate  on  Form  1010  (p.  227),  and  return  all 


^A  registrant  no  longer  h;is  the  right  or  privilege  of  applying  to  be  sent  to  a  Medical 
Advisory  Board. 


58 

three  copies  of  Form  1010  (p.  227)  to  the  Local  Board,  with  the  coii- 
chision  and  recommendation  in  the  case. 

Note  1. — Circular  letter,  January  9,  1918,  prohibiting  issuance  of  transporta- 
tion requests  for  more  than  one  way  for  sending  of  selected  men  to  camps  does 
not  nullify  section  123,  which  provides  for  the  sending  of  men  to  Medical  Advisory 
Boards.  In  these  cases  the  Local  Board  will  issue  two  transportation  requests, 
one  each  way.  This  rule  is  made  necessary  to  prevent  the  possibility  of  unau- 
thorized use  of  Government  transportation  other  than  for  selected  men  or  for 
men  being  sent  to  Medical  Advisory  Boards,  or  a  member  or  members  thereof. 
(Circular  letter,  Jan.  21.  191S.) 

Section  124.  Finding  by  Local  Board  as  to  physical  qualification. 

Upon  receipt  of  the  re^^ort  and  recommendation  of  the  Medical 
Advisory  Board  as  provided  in  section  123,  or,  if  the  case  has  not  been 
sent  to  the  Medical  Advisory  Board,  or  a  member  or  members 
thereof,  then  upon  the  receipt  of  the  report  of  the  examining  physi- 
cian, the  Local  Board  shall  make  its  decision  as  to  the  physical  quali- 
fication of  the  registrant.  If  the  registrant  is  found  physically  dis- 
qualified for  general  military  service,  the  Local  Board  shall  can- 
cel the  cross  mark  (X)  or  cipher  (0)  which  has  already  been  en- 
tered in  a  classification  column  by  drawing  a  red-ink  line  through 
such  cross  mark  or  cipher  and  shall  enter  the  classification  of  the 
registrant  in  Class  V,  column  12.  (See  sec.  102.)  If  the  registrant 
is  found  to  be  physically  disqualified  for  general  military  service,  but 
qualified  to  perform  special  and  limited  military  service  (see  sec. 
128|),  his  place  in  the  classi£cation  column  shall  not  be  changed,  but 
the  Local  Board  shall,  with  red  ink,  inscribe  a  l^old  circle  around  the 
cross  mark  (X)  or  cipher  (0)  in  such  classification  column.  (See 
sec.  188,  Part  Vin.)i 

Note  1. — Once  in  6very  month  the  Local  Board  shall  send  one  copy  of  Form 
1010  for  each  case  covering  a  registrant  who  Jias  been  finally  classified  in  V 
(G)  and  not  theretofore  so  sent,  to  the  draft  executive,  who  shall  assemble  these 
and  transmit  them  to  the  Surgeon  General  of  the  Army,  Washington,  D.  C. 
The  draft  executive  shall  keep  a  nominal  check  list  of  such  cases. 

While  men  found  disqualified  for  general  military  service  but  qualified 
for  special  and  limited  military  service  are  not  placed  in  Class  V,  they 
are  subject  to  induction  into  military  service  only  when  a  specific  call  for 
men  qualified  for  special  or  limited  military  service  only  is  made. 

If  the  finding  of  the  Local  Board  is  not  in  accord  with  the  recom- 
mendation of  the  Medical  Advisory  Board,  and  an  appeal  is  taken  to 
the  District  Board  from  the  decision  of  the  Local  Board  as  to 
the  physical  qualifications  of  the  registrant,  the  Local  Board  shall 
make  a  special  report  to  the  District  Board  of  its  reason  for  reject- 
ing the  recommendation  of  the  Medical  Advisory  Board. 

The  Local  Board  shall,  on  the  day  of  its  decision  as  to  the  physical 
qualification  of  any  registrant,  mail  to  such  registrant  a  notice  (Form 
1011,  sec.  283,  p.  231)  of  the  result  of  such  decision  and  shall  enter 

1  See  section  1281  foi"  deferred  remediable  group.  • 


59 

the  date  of  such  mailing  in  Golunin  21  of  the  Classificatoin  List  (Form 
1000,  p.  188.) 

NoTK  1. — See  section  12Si  concerning  deferred  remediable  group. 
Section  125.  Appeal  from  finding  of  Local  Board  as  to  physical  qualification.s. 

Within  five  days  after  the  date  of  the  notice  prescribed  in  section 
124  any  registrant  may  make  a  cLaim  of  appeal  to  the  District  Board 
from  the  finding  of  the  Local  Board  as  to  his  physical  qualification 
for  military  service.  Claim  of  appeal  shall  be  made  by  entering  the 
claim  in  the  place  provided  for  that  purpose  on  all  three  copies  of  the 
physical  examination  report  (Form  1010,  sec.  282,  p.  227).  The 
Government  Appeal  Agent  may  make  a  claim  of  appeal  on  behalf 
of  the  United  States  at  any  time. 

Immediately  upon  filing  of  an  appeal  from  the  decision  of  the 
Local  Board  as  to  physical  qualification,  the  Local  Board  shall  trans- 
mit to  the  District  Boai'd  all  three  copies  of  the  record  of  physical 
examination  (Form  1010,  p.  227)  in  the  case,  together  with  any  addi- 
tional evidence  as  to  physical  qualification  which  may  have  been 
submitted  to  the  Local  Board,  and  shall  enter  the  date  of  forwarding: 
such  record  in  column  22  of  the  Classification  List  and  in  the  place 
provided  on  the  Cover  Sheet. 

Note  1. — The  entry  of  the  registrant  on  the  Questionnaire  of  a  claim  of 
physical  disqualification'  is  not  to  be  construed  as  a  claim  from  wliic-h  an 
appeal  lies  to  the  District  Board  from  the  refusal  of  the  Local  Board  -to 
classify  the  registrant  in  Class  V  (G).  Appeals  from  classification  on  physical 
grounds  may  be  made  as  provided  in  sections  llii*  to  1:28,  inclusive,  and  not 
otherwise.     (Telegram  A-2142,  Jan.  3,  liJlS.) 

Section  126.  Action  by  District  Board  upon  appeal  as  to  physical  qualification. 
In  considering  a  case  appealed  on  the  ground  of  physical  qu^ilifica- 
tion,  the  District  Board  shall  neither  conduct  an}^  new  physical 
examination  nor  shall  it  receive  or  consider  any  evidence  which  was 
not  considered  by  the  Local  Board,  but  shall,  upon  consideration  of 
the  record  sent  to  it  as  prescribed  in  section  125,  either  aflirm,  modify, 
or  reverse  the  decision  of  the  Local  Board  and  promptly  enter  its 
finding  on  all  three  copies  of  Form  1010  (p.  227),  and  imnijediately 
return  the  same  to  the  Local  Board. 

Section  127.  Procedure  of  Local  Board  on  return  of  physical  examination 
record  from  District  Board. 

If  the  action  of  the  District  Board  on  appeal  as  to  physical  quali- 
fication changes  or  affects  the  classification  of  the  registrant  (see  sec. 
124),  the  Local  Board  shall  make  the  necessary  changes  in  the  Classi- 
fication List.  Whether  the  action  of  the  District  Board  changes  or 
affects  the  Classification  by  the  Local  Board  or  not,  the  Local  Board 
shall  mail  to  the  registrant  a  notice  (Form  1011,  sec.  283,  p.  231)  of 
the  result  of  the  decision  by  tlie  District  Board,  and  shall  enter  the 
date  of  mailing  of  such  notice  in  column  23  of  the  Classification  List. 


60 

Section  128.  Physical  examination  of  persons  not  in  Class  I. 

Local  Boards  may,  upon  the  application  of  registrants  in  Classes 
II,  III,  or  IV,  examine  such  registrants  physically,  pass  upon  their 
physical  qualifications,  and,  if  they  are  found  to  be  permanently 
disqualified,  to  classify  them  in  Class  V.  (See  sec.  79.)  This  is  not 
a  right  of  the  registrant,  but  it  is  a  privilege  that  may  be  accorded  by 
the  Local  Board  where  the  according  of  the  privilege  will  not  inter- 
fere with  the  prompt  and  orderly  execution  of  the  Selective  Service 
Law. 

Section  128 '/2.  Grouping  of  registrants. 

The  Regulations  governing  physical  examinations  prescribe  a 
standard  of  unconditional  acceptance  and  a  standard  of  uncondi- 
tional rejection.  Certain  cases  found,  upon  physical  examination  by 
a  Local  Board,  falling  between  these  two  standards  may  be  referred 
by  the  Local  Board  to  the  Medical  Advisory  Board  or  to  some  mem- 
ber in  the  same  manner  as  other  cases  that  are  required  or  authorized 
by  these  Regulations  so  to  be  referred.  Cases  so  referred  as  falling 
between  these  two  standards,  and  cases  referred  to  Medical  Advisory 
Boards,  or  member  thereof,  under  the  other  provisions  of  these  Regula- 
tions, shall  be  examined  by  the  IMedical  Advisory  Boards  or  such 
member  or  members  thereof,  who  shall  advise  the  Local  Boards  to : 

(a)  Accept  the  registrant  as  physically  qualified  for  general  mili- 
tary service;  or 

(h)  Accept  the  registrant  as  physically  qualified  for  general  mili- 
tary service  when  cured  of  (naming  remediable  defect  for 

which  acceptance  is  authorized)  ;  or 

(c)  Accept  the  registrant  as'  pln^sicalb/  qualified  for  special  or 
limited  military  service  in  a  named  occupation  or  capacity ;  or 

(d)  Reject  the  registrant; 

and  shall  record  their  finding  in  the  proper  spaces  provided  on  Form 
1010. 

Local  Boards  shall  find  a  registrant  physically  qualified  for  gen- 
eral military  ser\dce  (Rule  a  above)  only  when  he  falls  within  the 
standard  of  unconditional  acceptance  as  prescribed  in  sections  182 
to  188,  inclusive,  as  further  explained  and  amplified  by  the  Standards 
of  Physical  Examination,  including  cases  of  slight  remediable  defects 
not  included  under  foregoing  Rule  h. 

Local  Boards  shall  find  a  registrant  physically  qualified  for  gen- 
eral military  service  when  cured  of  a  remediable  defect  (Rule  h  above) 
only  in  those  cases  when  such  acceptance  is  specifically  authorized; 
namely,  when  a  registrant  is  found  to  fall  within  the  "Deferred 
remediable  gTOup." 

AVhen  a  Medical  Advisory  Board,  or  a  member  or  members  thereof, 
to  whom  a  registrant  has  been  sent  determine  tlnit  a  registrant 
fchould  be  accepted  for  general  military  service  when  cured  of  such 


61 

remediable  defects  (Rule  h  above)  the  Medical  Advisory  Board,  or 
such  member  or  members,  shall  insert  in  ink  in  the  space  provided 
on  page  2  of  Form  1010,  under  the  general  heading,  "  Physical  ex- 
amination by  Medical  Advisory  Board,"  and  the  following  words: 
"  Physically  qualified  for  general  military  service,"  the  words  "  when 

cured  of "  followed  by  the  name  or  diagnosis  of  the  remediable 

defect,  which  name  or  diagnosis  is  to  be  followed  by  a  circle  in 
black  ink.  Upon  return  to  the  Local  Board  of  the  record  (Form 
1010,  p.  227)  in  such  a  case,  and  if  the  finding  of  the  Medical  Ad- 
visory Board,  or  such  member  or  members  thereof ,  is  confirmed  by  the 
Local  Board,  the  registrant's  place  in  the  classification  column  shall 
not  be  changed,  but  the  Local  Board  shall,  with  black  ink,  inscribe 
a  bold  circle  around  the  cross  mark  (X)  or  cipher  (0)  in  such  classi- 
fication column;  and  such  registrant  shall  be  inducted  into  military 
service  after  his  order  number  is  reached,  but  only  at  such  time  as 
may  be  designated  by  a  call  issued  by  the  Provost  ]\Iarshal  General. 

Eegistrants  shall  be  found  "  physically  qualified  for  special  or 
limited  military  service"  (Rule  c  above)  onh'  in  those  cases  de- 
scribed in  the  Standards  of  Physical  Examination,  and  in  such  cases 
the  Boards  shall  designate  the  occupation  or  class  of  service  for 
which  such  persons  are  physically  qualified  in  the  space  provided  on 
Form  1010  (p.  227)  after  the  words  "  physically  qualified  for  special 
or  limited  military  service  as  ,"  and  the  same-  shall  be  indi- 
cated on  the  Classification  List  as  provided  by  section  124. 

Registrants  shall  be  found  as  physically  deficient  and  not  physi- 
cally qualified  for  military  service  (Rule  d  above)  only  when  they 
fall  within  the  standards  of  unconditional  rejections  as  prescribed  in 
sections  182  to  188,  inclusive,  as  further  explained  and  amplified  by 
the  Standards  of  Physical  Examination. 

When  a  Medical  Advisory  Board  or  a  member  or  members  thereof 
delay  the  examination  of  a  registrant  on  account  of  temporary  de- 
fects, it  or  they  must  return  to  the  proper  Local  Board  Form  1010 
(p.  227),  with  a  statem.ent  attached  thereto  (but  not  written  thereon) 
stating  the  reason  for  delay  and  fixing  a  definite  period  of  time 
witliin  which  the  registrant  ma}^  be  sent  back  to  it  or  them.  At  the 
end  of  said  period,  or  earlier,  if  it  believes  the  temporary  defect  is 
removed,  the  Local  Board  shall  send  the  registrant  back  to  the 
Medical  Advisory  Board,  unless  the  Local  Board  believes  that  the 
examination  should  be  further  delayed  or  that  further  refertnce  to 
tlie  Medical  Advisory  Board,  is  unnecessary,  and  may  proceed  Avith- 
out  further  reference. 

Local  Boards  may  aocei^t  a  registrant  as  physically  qualified  for 
special  or  limited  military  service  in  a  named  occupation  or  capacity 
without  reference  to  the  Medical  Advisory  Board. 

Note   1. — The    foregoing   regulations  clearly    indicate   the   foiu-  groups   into 
whicli  registrants  should  be  grouped  by  Local,  District,  and  Medical  Advisory 


62 

Boards  as  a  result  of  the  physical  examinations  in  accordance  with  the  Manual 
of  Standards  of  Physical  Examination. 

In  other  words,  Group  A  shall  contain  registrants  found  to  be  qualified  for 
general  military  service  within  the  standards  of  unconditional  acceptance, 
including  registrants  with  slight  remediable  defects. 

Registrants  with  slight  remediable  defects  shall  be  held  physically  qualified 
for  general  military  service,  if  not  remedied  pending  orders. 

All  registrants  coming  within  the  foregoing  definition  and  as 
specifically  indicated  in  the  instructions  in  the  Manual  are  to  be 
included  in  Group  A  and  reported  as  physically  qualified  for 
general  military  service  in  the  place  indicated  on'  Form  1010 
(p.  227). 

Group  B  shall  contain  registrants  who  are  found  to  be  phys- 
ically qualified  for  general  military  service  when  cured  of  some 
remediable  defect  which  is  of  such  a  character  that  it  must  be 
remedied  or  cured  before  the  registrant  can  be  ordered  into  service. 

Group  C  shall  contain  registrants  who  are  found  not  to  be  within 
the  standard  of  unconditional  acceptance  on  account  of  defects  which 
are  not  remediable  nor  sufficiently  incapacitating  to  bring  them 
within  the  condition  of  unconditional  rejection.  This  is  the  group 
of  registrants  who  may  be  found  to  be  qualified  for  special  or  limited 
military  seiwice. 

Group  D  shall  contain  all  registrants  coming  within  the  standards 
of  unconditional  rejection  and  includes  all  cases  not  included  in 
Groups  A,  B,  and  C.  Such  registrants  must  be  reported  on  Form 
1010  (p.  227)  as  "  Physically  deficient  and  not  physically  qualified  for 
military  service  by  reason  of '•  (the  reason  for  the  disqualifica- 
tion to  be  stated  in  the  blank  provided). 

In  arriving  at  their  decisions  concerning  the  physical  qualifications 
of  registrants  Boards  must  be  governed,  as  to  the  grouping  of  regis- 
trants, by  the  specific  instructions  contained  in  Manual  of  Standards 
of  Physical  Examinations. 

Note  2. — Whenever  it  shall  appear  to  a  Local  Board  or  to  a  Medical  Advisory 
Board  that  a  registrant  is  suffering  from  self-inflicted  or  purposely  caused 
physical  defects  which,  under  the  Standards  of  Physical  Examinations,  would 
render  him  disqualified  for  military  service  of  any  kind,  a  full  statement  of 
the  facts  and  of  the  condition  of  the  registrant  and  of  the  Board's  recommenda- 
tion shall  be  prepared  and  attached  to  Form  1010  (p.  227),  and  one  copy  of 
Form  1010,  with  such  statement  attached,  shall  immediately  be  sent  by  the 
Local  Board  to  the  Adjutant  of  the  State  to  be  transmitted  to  the  Provost 
Marshal  General  in  order  that  the  case  may  be  submitted  to  the  Surgeon  Gien- 
eral  and  The  Adjutant  General  of  the  Army  for  a  waiver  of  the  physical  defects, 
if  recommended,  so  that  the  registrant  may  be  compelled  to  render  military 
service. 

Note  3. — When  in  the  opinion  of  the  Local  Board  the  registrant  is  believed 
to  be  feigning  disease  or  illness  or  physical  defect,  which  can  not  be  detected 
l)y  careful  examination,  the  Local  Board  shall  note  on  Form  1010  its  opinion 
that  registrant  is  feigning  in  order  to  avoid  service.     (See  sec.  171,  Form  75.) 


63 

Note  4. — The  foregoing  sections  122  to  12Si,  inclusive,  and  sections  141-143 
reliite  to  the  procedure  concerning  pliysical  .examinations.  For  rules  and 
standards  as  to  physical  qualifications  governing  examining  physicians,  see 
Part  VIII,  sections  182  to  188,  inclusive,  and  Foi-ni  75,  "  Standards  of  Physical 
Examination." 

Note  5. — Great  care  must  be  taken  in  observing  the  difference  in  the  standards 
of  physical  examination  as  between  registrants  to  be  inducted  into  the  Army 
and  those  to  be  inducted  into  the  Navy. 

Section  177.  Disposition  of  registrants  rejected  or  discharged  from  military^ 
service  at  a  mobilization  camp. 

When  any  selected  man,  prior  to  acceptance,  is  rejected  at  a  mobi- 
lization camp,  the  commanding  officer  thereof  shall  promptly  notify 
his  Local  Board  of  the  fact,  canso  (stating  at  length  the  details),  and 
date  of  rejection,  on  Form  1020-A,  and  the  Provost  Marshal  General, 
on  Form  1029-B.  When  any  selected  man  is,  subsequent  to  accept- 
ance, discharged  at  a  mobilization  camp,  the  commanding  officer 
thereof  shall  similarly  notify  the  Local  Board,  using  Form  1029-C, 
and  the  Provost  Marshal  General,  using  Form  1029-D.  (Sec.  305, 
p.  254.) 

Immediately  upon  receipt  of  i\otice  of  the  rejection  or  discharge 
of  any  selected  man,  the  Local  Board  shall  reclassify  the  registrant 
in  accordance  with  his  status  as  determined  by  the  action  of  the 
militar}^  authorities  in  rejecting  or  discharging  him  and  shall  then 
proceed  in  the  following  manner : 

(a)  If  the  rejection  or  discharge  was  because  of  j)hysical  disquali- 
fication, the  Local  Board  shall  reclassify  the  registrant  in  class  I  and 
shall  direct  him  to  aj^pear  before  it  for  further  physical  examination, 
and  if,  after  thorough  physical  reexamination,  the  Local  Board  dis- 
covers the  physical  defect  found  by  the  examining  surgeon  at  the 
mobilization  camp,  the  classification  as  determined  b}^  the  command- 
ing officer  of  the  mobilization  camp  shall  stand.  If,  after  thorough 
physical  reexamination,  the  Local  Board  does  not  discover  the  dis- 
qualifying defect,  it  shall  refer  the  registrant  to  a  Medical  Advisory 
Board  or  a  member  or  members  thereof  for  exhaustive  reexamina- 
tion, advising  the  Medical  Advisory  Board  or  such  member  or  mem- 
bers of  the  fact  that  the  registrant  has  been  rejected  at  the  mobiliza- 
tion camp  and  specifically  stating  the  jcause  of  rejection  as  reported 
by  the  commanding  officer.  The  Medical  Advisory  Board  or  such 
member  or  members  shall  make  an  exhaustive  examination  of  the 
registrant,  particularly  as  regards  the  physical  disqualifications  as 
found  by  the  examining  surgeon  at  the  mobilization  camp  and  shall 
report  its  findings  to  the  Local  Board.  The  Local  Board'  shall  pro- 
ceed to  a  decision  as  to  the  physical  qualifications  of  the  registrant 
and  shall  forward  the  record  to  the  District  Board  for  approval  or 
disapproval  of  its  findings.     Upon  the  return  of  the  record  from  the 


G4 

District  Board  the  Local  Board  shall  reclassif}^  the  registrant  in 
accordance  with  the  findings  of  the  District  Board. 

{h)  If  the  rejection  or  discharge  at  the  mobilization  camp  was 
because  of  any  reason  other  tha.n  that  of  physical  disqualification  the 
Local  Board  shall  proceed  to  an  investigation  of  the  case,  and  if  in 
the  opinion  of  the  Local  Board  an  error  was  made  in  the  rejection  or. 
discharge  the  entire  record  shall  be  referred  to  the  Adjutant  General 
of  the  State,  who,  if  he  approves  the  findings  of  the  Local  Board, 
shall  refer  the  record  to  the  commanding  officer  of  the  mobilization 
camp  for  his  consideration,  recommendation,  and  return  through  the 
Adjutant  General  of  the  State  to  the  Local  Board. 

In  all  cases  so  referred  to  the  commanding  officer  of  the  mobiliza- 
tion camp  and  not  returned  by  him  within  a  reasonable  time,  or 
returned  by  him  without  recommendation,  or  returned  by  him  with  a 
recommendation  disapproving  the  findings  of  the  Local  Board,  the 
Adjutant  General  of  the  State  shall,  if  in  his  opinion  the  same  be 
necessary,  forward  the  entire  record  to  the  Provost  Marshal  General 
for  instructions  as  to  further  procedure.^ 
Section  182.  Preliminary  statement. 

In  view  of  the  contemplation  of  a  further  investigation  and  classi- 
fication of  registrants  physicall}^  qualified  for  special  and  limited 
military  service  who  have  not  the  physical  qualifications  for  general 
military  service,  and  in  view  of  the  decision  to  accept  some  regis- 
trants for  general  military  service  with  remediable  defects,  who  are 
otherwise  physically  and  mentally  qualified  for  military  service,  the 
following  new  regulations  for  the  physical  examination  of  regis- 
trants by  the  physician  of  the  Local  Board  becomes  necessary : 

Local  Boards  can  accept  registrants  for  general  military  service 
only,  when  they  come  within  the  standards  for  unconditional  accept- 
ance, with  or  without  remediable  defects. 

Local  Boards  can  reject  registrants  for  general  military'-  service 
onl}^  when  the  registrant  comes  within  the  standards  of  uncondi- 
tional rejection. 

Local  Boards  may  accept  registrants  for  special  and  limited  mili- 
tary service,  but  must  refer  all  doubtful  cases  to  the  Medical  Ad- 
visory Board  or  a  member  or  members  thereof. 

Physicians  on  the  Local  Board  are  not  required  to  make  a  com- 
plete examination  of  every  registrant.  The  moment  the  physician 
on  the  Local  Board  finds  a  mental  or  a  physical  defect  placing  the 
registrant  within  the  standards  of  unconditional  rejection  the  phy- 
sician on  the  Local  Board  shall  indicate  this  in  Form  1010  (sec.  282, 
p.  227),  after  "physically  deficient  and  not  physically  qualified  for 

^  If  any  doubt  arises  as  to  rejected  men,  their  cases  may  be  talcen  up  directly  with  the 
camp  commander,  or  the  facts  communicated  to  this  office,  as  may  be  most  expedient. 


65 

military  service  by  reason  of,"  and  shall  in  the  space  following, 
write  the  disqualifying  defect. 

In  all  other  cases  the  Local  Board  shall  make  a  complete  examina- 
tion of  registrants;  and,  when  the  physician  of  the  Local  Board  finds 
a  defect  which  docs  not  come  within  the  standards  of  unconditional 
rejection  but  does  take  the  registrant  out  of  the  class  within  the 
standards  of  unconditional  acceptance,  he  shall  proceed  to  make  a 
complete  examination  and  may  then,  if  in  doubt,  refer  the  registrant 
to  the  Medical  Advisor}^  Board,  or  a  member  or  members  thereof, 
reporting  the  result  of  the  complete  examination,  including  a  report 
of  the  defect  or  defects  on  Form  1010  (p.  227). 

Registrants  ca,n  not  be  declared  physically  qualified  for  general 
military  service  (see  Form  1010,  sec.  282,  p.  227,  S.  S.  R.)  until  the 
complete  examination  has  been  made  by  the  physician  on  the  Local 
Board,  with  the  finding  that  the  candidate  comes  in  everv  instance 
within  the  standards  of  unconditional  acceptance  with  or  without 
remediable  defect.  Then,  it  is  so  noted  and  recorded  on  Form  1010 
(sec.  282,  p.  227,  S.  S.  R.),  and  if  there  is  a  remediable  defect  this  is 
also  recorded  after  "  physically  qualified  for  general  military  service." 

Section  183.  Place,  order,  and  method  of  examination. 

For  material,  see  Form  75,  "  Standards  of  Physical  Examination." 

Section  184.  Causes  for  rejection. 

For  material,  see  Form  75,  "  Standards  of  Physical  Examination." 

Section  185.  Dental  requirements. 

For  material,  see  Form  75,  "  Standards  of  Phj^sical  Examination." 

Section  IBG.  Degree  of  deficiency  for  disqualification. 

In  these  regulations  the  standards  for  unconditional  rejection 
which  place  the  registrant  in  the  class  physically  deficient  and  not 
physically  qualified  for  military  service  are  clearly  defined.  When 
the  Local  Board  is  in  any  doubt,  the  registrant  should  be  referred  to 
the  Medical  Advisory  Board,  or  a  member  or  members  thereof.  The 
attention  of  Local  Boards  and  examining  physicians  is  called  to  sec- 
tion 123. 

Section  187.  Temporary  defects. 

Registrants  confined  to  their  homes  or  hospitals,  or  who  present 
themselves  with  some  temporary  defect,  the  result  of  an  acute  disease, 
injury,  or  operation,  or  Avho  are  waiting  for  operation,  should  be 
granted  a  reasonable  delaj^  for  completing  the  physical  examination. 

All  of  these  cases  should  be  thoroughly  investigated  by  the  physi- 
cian 6n  the  Local  Board. 

Registrants  with  contagious,  communicable,  reportable  diseases 
should  not  be  ordered  before  the  Local  Board  for  examination  until 
they  are  discharged  by  the  boards  of  health. 


66 

Eegistrants  recovering-  from  diphtheria  should  not  be  ordered  to 
the  cantonments  until  three  negative  cultures  at  intervals  of  three 
days  have  been  obtained  from  the  throat  and  nose.  In  localities 
where  there  is  no  provision  for  this  bacteriological  v^'ork,  consult  the 
municipal  or  State  health  authorities,  or  United  States  Public  Health 
Sei-^ace. 

Section  188.  Special  and  limited  military  service. 

In  view  of  the  importance  of  a  thorough  investigation  and  classi- 
fication of  registrants  belonging  to  this  group,  Local  Boards  are  re- 
quired to  refer  to  the  Medical  Advisory'  Boards,  or  some  member  or 
members  thereof,  all  such  registrants  concerning  whose  qualifications 
there  may  be  doubt. 

The  physician  of  the  Local  Board  is  urged  to  consult  with  the  Medical 
Advisory  Board  about  this  group  and  to  familiarize  himself  with  the 
specific  regulations  concerning  special  and  limited  military  service. 

Note  1. — See  section  177  ami  Form  75,  "  Standards  of  Physical  Examination." 
Note  2. — For  rules  of  procedure  couceruing  physical  examinations,  see  sections 

122  to  12SJ  and  141  to  143,  inclusive. 

Note  3. — Great  care  must  be  talien  in  observing  the  difference  in  the  standards 

of  pliyslcal  examination  as  between  registrants  to  be  inducted  into  the  Army 

and  those  to  be  inducted  into  the  Navy.     (See  sec.  5.) 

Section  196.  Examining  physicians — Rate  of  pay. 

It  is  the  duty  of  any  physician  who  is  a  member  of  a  Local  Board 
to  make  ph3sical  examinations,  and  additional  examining  physicians 
should  be  compensated  only  where  acceptable  gxtttuitous  service  can 
not  be  obtained,  and  where,  in  accordance  with  section  42,  the  com- 
pensation of  an  examining  physician  in  addition  to  the  physician 
member  of  the  board  is  authorized. 

Physician  members  of  Local  Boaras  and  examining  ph3^sician3 
not  members  of  Local  Boards  may  receive  compensation  at  the  rate 
of  $1  per  hour  for  each  hour  that  they  are  actually  present  at  the 
office  of  the  Board  and  fully  engaged  in  the  duties  of  making 
l^hysical  examinations,  but  not  in  any  case  to  exceed  $7.50  for  any 
single  day  or  $150  for  any  single  month. 

Note  1. — The  compensation  provided  in  tlie  above  section  for  physician  mem- 
bers of  Local  Boards  is  in  addition  to  that  provided  for  their  services  as  mem- 
bers of  Local  Boards  under  section  195  of  these  regulations,  subject,  however, 
to  the  provisions  of  note  to  section  190  of  these  regulations. 

RULES  OF  PROCEDURE  FOR  MEDICAL  ADVISORY  BOARDS. 

(1)  Read  carefully  the  Selective  Service  Regulations  (S.  S.  R.), 
particularly  the  following  sections:  26,  29,  33,  42,  43  (<?),44,  46, 122 to 
128i,  177,  182,  186  to  188,  196.  For  ready  reference  all  of  these  sec- 
tions are  reprinted  in  this  appendix. 


67 

(2)  Medical  Advisory  Boards  shall  consist  of  tlii-ee  or  more  phy- 
sicians. The  desirable  miniinuiii  consists  of  one  each  of  the  following? 
Specialists:  Internist;  ej'.e,  ear,  nose,  and  throat;  orthor)edist ;  sur- 
geon ;  psychiatrist ;  radiographer ;  dentist.  Additional  Medical  Ad- 
visory Boards  ma}^  be  formed.  The  membership  of  existing  boards 
may  be  increased  as  necessity  may  indicate,  but  should  not  exceed  10 
members.  (See  sec.  29,  S.  S.  R.)  When  a  Medical  Advisory.  Board 
believes  that  other  boards  should  be  created,  or  additional  members 
added  to  existing  boards,  it  should  recommend  the  same  to  the  gov- 
ernor through  the  Medical  Aide. 

(3)  Each  board  should  select  one  member  as  chairman,  one  as  vice 
chairman,  and  one  as  secretary.  Sessions  will  be  held  only  when 
necessary  for  the  conduct  of  general  business. 

(4)  Request  to  the  governor  for  authority  to  employ  clerical  as- 
sistance and  incur  other  expenses  should  be  made  only  when  abso- 
lutely necessary.  Do  not  incur  any  expense  mitil  authorized  b}^  tlie 
governor.  (Se«  sees.  43(a),  198,  204,  and  208,  S.  S.  E.)  Stationery 
will  be  supplied  by  the  Adjutant  General. 

(5)  No  communications  concerning  the  business  of  Medical  Ad- 
visory Boards  should  be  addressed  to  any  department  or  official  in 
Washington.  Except  for  their  communications  with  Local  Boards 
and  Medical  Aides,  Medical  Advisory  Boards  must  address  all  offi- 
cial communications  of  every  character,  whether  reports,  recom- 
mendations, or  requests  for  instructions  or  for  interpretations  to  tlic 
Adjutant  General  of  the  State,  who  will  either  respond  thereto  or 
transmit  the  same  to  the  proper  authoritv.  (See  sec.  29,  Note  3, 
S.  S.  R.) 

(6)  A  place  will  be  salected  as  headquarters  of  the  board  where 
sessions  may  be  held  and  physical  examinations  conducted.  This 
should  be  preferably  a  hospital  or  similar  institution,  where  proper 
and  careful  examinations  can  be  made.  It  ought  not  to  be  necessary 
to  ]Day  rental  for  such  headquarters;  but  in  the  event  that  no  free 
quarters  can  be  obtained,  application  must  be  made  througli  the 
Adjutant  General  of  the  State  to  the  governor  for  authority  to  incur 
expense  for  rent.  Physical  examinations  should  be  conducted  at 
headquarters  of  the  board  when  practicable;  exceptionally,  Avhen 
necessity  for  prompt  action  exists,  an  Advisory  Board  member  may 
conduct  his  part  of  the  examination  at  his  office. 

(7)  A  majority  of  the  board  shall  constitute  a  quorum.  The  board 
shall  decide  all  disputed  questions  by  vote.  The  chairman  need  not 
vote  except  to  break  a  tie. 

(8)  It  shall  not  be  necessary  for  all  or  a  majority  of  a  board  to  be 
present  at  or  to  participate  in  the  examination  of  a  registrant.  Such 
registrant  may  be  referred  to  the  appropriate  member  or  members, 
whose  opinion  is  desired. 


68 

(9)  Any  member  of  the  board  can  sign  Form  1010,  reporting  tlie 
result  of  ph3^sical  examination  by  the  Medical  Advisory  Board,  des- 
ignating the  signer  as  follows :  "  Chairman,"  "  vice  chairman,"  "  sec- 
retar3^"  or  "  member." 

(10)  Form  1010  will  be  promptly  completed  by  the  Medical  Ad- 
visory Board,  or  by  the  member  or  members  who  have  examined  the 
registrant,  and  will  be  at  once  returned  in  triplicate  to  the  Local 
Board  by  which  issued.  If  registrant  has  been  examined  at  the  re- 
quest of  the  Adjutant  General,  Form  1010,  when  completed  by  the 
Medical  Advisory  Board,  shall  be  returned  in  triplicate  to  the  Adju- 
tant General.     (See  sec.  13T,  S.  S.  E.) 

(11)  If  clerks  are  employed  they  are  to  be  on  duty  at  place  of 
meeting  dail^'^,  except  Sundays  and  legal  holidays,  from  9  a.  m.  to 
5  p.  m.,  and  shall  keep  all  records  and  conduct  all  correspondence 
under  the  direction  of  the  board. 

(12)  No  permanent  record  is  required  to  be  kept  by  Medical  Ad- 
visory Boards  except  a  minute  book,  which  shall  contain  a  list  of  reg- 
istrants whose  examination  has  been  completed,  and  another  list  of 
those  Avhose  examination  is  delayed  on  account  of  temporary  defects. 
The  following,  or  substantially  ecjuivalent  form,  which  is  not  sup- 
plied but  must  be  written  or  typewritten,  will  be  entered  in  the  book 
as  a  record  of  formal  meetings. 

Date  of  meeting Convened M.    Adjourned M. 

Present  (members  of  board).  •  Arrived.  Left. 


Business  Transacted. 

Names  of  cases  referred  by  the  Local  Board 

Number  finally  acted  on 

Names  of  cases  referred  by  registrar  or  Appeal  Agent 

Number  finally  acted  on 

Names  of  cases  referred  by  The  Adjutant  General 

Number  finally  acted  on 

Names  of  cases  transfei'red  from  Local  Boards 

Number  finally  acted  on 

(13)  Medical  Advisory  Boards  must  conduct  all  their  proceedings 
in  strict  accordance  with  the  Standards  of  Physical  Examinations 
and  the  Selective  Service  Regulations. 

(14)  xVll  inquiries,  requests  for  interpretations,  reports,  and  com- 
munications of  every  character   (except  those  with  Local  Boards) 


69 

must  be  addressed  to  the  Governor  or  State  Adjutant  General, 
thrcugli  the  medical  aid  to  the  governor.  When  necessary,  such 
communications  will  be  forwarded  through  proper  channels  to  the 
Provost  Marshal  General.     (See  sec.  25,  S.  S.  E.) 

(15)  Definite  and  explicit  instructions  with  respect  to  headquar- 
ters, expenses,  correspondence,  and  standards  of  examinations  will 
be  found  in  the  text  of  Form  75  and  the  Selective  Service  Eegulations. 

(16)  When  registrants  referred  to  the  Advisory  Board  present 
themselves  with  some  temporary  defect,  the  result  of  a  recent  acute 
disease,  injury,  or  operation,  the  Local  Board  should  be  advised  to 
grant  a  reasonable  time  for  recovery  before  the  final  examination  by 
the  Medical  Advisory  Board  is  made. 

(17)  When  Local  or  Advisory  Boards  can  not  command  the  facili- 
ties at  the  hospital  headquarters  for  making  throat  cultures  of  regis- 
trants recovering  from  an  attack  of  diphtheria  as  directed  in  section 
187  in  the  Regulations  for  Local  Boards,  the  cultures  from  the 
throats  of  such  registrants  may  be  sent  by  mail  to  municipal  labora- 
tories or  to  those  of  the  State  or  of  the  United  States  Public  Health 
Service. 

(18)  The  Medical  Advisory  Board  may  employ  section  187,  S.  S.  R., 
"Temporary  Defects,"  when  they  desire  to  grant  the  registrant  a 
reasonable  delay  for  completing  the  ph3'sical  examination  when  it  is 
difficult  or  impossible  to  come  to  a  definite  conclusion  when  the  regis- 
trant first  presents  himself  to  the  ^ledical  Advisory  Board. 

(19)  Whenever  possible  examinations  should  be  completed  within, 
one  day.  Medical  Advisory  Boards  in  those  districts  in  which  the 
registrants  must  be  sent  from  a  distance  should  suggest  to  their  Local 
Boards  to  hold  registrants  under  section  187,  S.  S.  E.,  for  a  reasonable 
time  until  the  examination  can  be  so  completed. 


INDEX. 


I  References  are  to  sections.     See  also  index  to  appendix  on  page  73.] 

Sections. 

Abdomen,  concerning , S5-94 

Alcoholism,    chronic 110, 118 

Anemia,  progressive,  pernicious,  secondary,  splenic 156-157 

Anesthetic,  use  of,  in  diagnosis 18 

Apices,    lungs 138 

Blood  vessels,  concerning 140-146 

Brain,  organic  diseases  of 121-129 

Cancer,  concerning 157 

Chest,  standard  measurements 78-S4 

Chest  wall,  concerning 130-132 

Chronic  alcoholism 110, 118 

Clinical  forms  of  insanity 119, 120 

Debility,  concerning 156 

Dental  requirements 47-52 

District  Boards,  jurisdiction  and  powers  of  {see  Appendix) 10 

Drug,  addiction  to,  concerning 108 

Ears,  concerning 35-41 

Epilepsy,  concerning '110, 114 

Esophagus,  concerning 42-46 

Examinations,  order  and  method  of 17-19 

Extremities,  concerning 72-77 

Eyes,  concerning 20-34 

Fauces,  concerning ^ 42-46 

Feet,  defects  of 72-77 

Fingers,    concerning 72-75 

Genito-urinary  organs,  concerning 100-106 

Groups  indicating  physical  qualifications  (sec.  1281,  S.  S.  R. ) 4 

Hands,  concerning 72-75 

Head,  concerning 57-59 

Hearing,  concerning 35-41 

Heart,  concerning 140-154 

Height,  standard  measures-! 78-84 

Hemophilia 156 

Idiocy,  concerning 110, 116 

Illness  and  injuries  confining  to  home,  etc.,  concerning 158 

Imbecility,  concerning 110, 117 

Injuries,  confining  to  home,  etc..  concerning 158 

Insanity : 

Concerning 110. 113 

Clinical   forms  of 119. 120 

Larynx,  concerning 42-46 

(70) 


/ 
71 

Sections. 

Local  Boards,  jurisdiction  powers  (see  Appendix) 4-10 

Lumbo-sacral  joints,  concerning GG-69 

Lungs  and  cbest  wall,  concerning 130-139 

Malaria,  acute  or  chronic,  concerning I55 

Malingering : 

Notes  on 16i-177 

Hearing,  test  to  detect 40,  41 

Vision,  test  to  detect 27-34 

Marine  Corps,  requirements  for 5,  20 

Measurements,  directions  and  standards 78-S4 

Medical  Advisory  Boards,  concerning  (see  Appendix) 7-lG 

Medical  Aide,  concerning  {see  Appendix) 11 

Mental  diseases,  concerning : 107-129 

Metallic  poisoning,   irremediable 3  57 

Military  authorities,  powers  of 13 

]\routh,    concerning 42-4G 

Murmurs  of  heart,  concerning 140-154 

Navy,  requirements  for 5.  20 

Neck,  concerning 95-99 

Nerves,  peripheral,  organic  diseases  of , 121-129 

Nervous  diseases,  concerning 107-129 

Nose,  concerning 42-4G 

Order  of  examination 17-19 

Organic  diseases,  brain,  spinal  cord,  peripheral  nerves 121-129 

Pellagra,  concerning 157 

Peripheral  nerves,  organic  diseases  of 121-129 

Pharynx,   concerning 42— 4G 

Plurisy,    concerning 130-137 

Kules,  preliminary  and  general 1-lG 

Sacro-iliac  and  lumbo-sacral  joints . 66-G9 

Scapulas,  concerning • 70-71 

Skin,  concerning 53-5G 

Spinal  cord,  organic  diseases  of 121-129 

Spine,  concerning ^ 60-G9 

Standards  of  physical  examination : 

Purpose  and  use  of 1 

To  whom  applicable 2-3 

Temporary  defects,  concerning 159-162 

Teetli,  definitions,  etc 47-52 

Thumbs,  concerning 72-75 

Trachea,   concerning 42^G 

Tuberculosis : 

Diagnosis  of,  in  general ■ 132-139 

X-ray,  uses  of 139 

Venereal  diseases,  concerning 100-lOG 

Weight,  measurements,  standards 7S-S4 

X-ray  plates,  use  of 46,  65,.  90,  105,  152 


INDEX  TO  APPENT3IX. 


[References  are  to  pages.]  Page. 

Clerical  assistance,  appointment,  expenses,  etc.  (sec.  43,  S.  S.  R.) 55 

Correspondence  rules  (sec.  25,  S.  S.  R.) • 52 

District  Boards : 

Appeals  to  (sec.  125,  S.  S.  R.) 59 

Powers  and  duties  (sec.  126,  S.  S.  R.) 59 

Status  of  (sec.  33,  S.  S.  R.) 53-54 

Grouping  of  registrants  as  to  pliysical  qualifications  (sec.  12S^,  S.  S.  R.)_  60-G2 

Local  Boards : 

Appeals  from  findings  (sec,  125,  S.  S.  R.) 59 

Powers  and  duties  (sees.  122-128^,  S.  S.  R.) 56-57,00-62 

Procedure  as  to  returned  records  (sec.  127,  S.  S.  R.) 59 

Registrants  grouped  by  (sees.  12SA,  182,  S.  S.  R.) 00-62,04-65 

Status  of  (sec.  33,  S.  S.  R.) 53-54 

Jledical  Advisory  Boards : 

Appointments,  etc.  (sec.  29,  S.  S.  R.) 52-53 

Clerical  assistance  for  (sec.  43,  S.  S.  R.) 55 

Dentists  on  (sees'.  42,  44,  S.  S.  R.,  notes) 55 

Duties  and  personnel  of  (sees.  44,  123,  S.  S.  R.) 55,  57-58 

Rules  of  pi-ocalure  for 66-69 

State  districts  under  (sec.  29,  S.  S.  R.) 52-53 

Medical  Aide  to  Governor : 

Appointment  (sec.  29,  S.  S.  R.) 52-53 

Duties  of  (sec.  29,  S.  S.  R.) 52-53 

Physical  examination : 

Appeals  from  finding  of  Local  Boards  (sec.  125,  S.  S.  R.) 59 

Disqualification,  degree  of  deficiency  for  (sec.  186,  S.  S.  R.) 65 

Doubtful  cases  sent  to  Medical  Advisory  Board  (sec.  123,  S.  S.  R.)___  57-58 

Finding  by  Local  Board  (sec.  124,  S.  S.  R.) 58 

Grouping  of  registrants  after  (sec.  1284,  S.  S.  R.) 60-62 

Persons  not  in  class  1  (sec.  128,  S.  S.  U.) 59 

Powers  and  duties  of  District  Boards  (sec.  126,  S.  S.  R.) 59 

Powers  and  duties  of  Local  Boards  (sees.  122-128J,  S.  S.  R.)—  56-57,  60-62 
Powers    and    duties   of   Medical    Advisory    Boards    (sees.    44,    123, 

S.  S.  R.) 55,57-58 

Procedure  governing  (sees.  122-128^,  S.  S.  R.) 56-57,60-62 

Qualifications  (sees.  128*,  182,  S.  S.  R.) 60-62,04-05 

Reexamination  of  rejected  and  discharged   registrants,  when    (sec. 

177,  S.  S.  R.,  note) 03-04 

Physit'fil  qualifications : 

Concerning  (sees.  128^,  182,  S.  S.  R.) -.  60-62,64-65 

Degree  of  deficiency  disqualifying  (sec.  186,  S.  S.  R.) 05 

Special  and  limited  military  service  (sec.  ISS,  S.  S.  R.) 66 

Temporary  defects  (sec.  187,  S.  S.  R.) 65 

Physicians.,  examining : 

Additional,  appointment  and  duties  (sec.  42,  S.  S.  R.) 54-55 

Duties  generally  (sec.  46,  S.  S.  R.) 55-56 

Pay  of,  rate  of  (sec.  196,  S.  S.  R.) 66 

Registrants,  how  grouped  (sees.  1284,  182,  S.  S.  R.) 60-62 

Rejected  or  discharged  men,  disposition  of  (sec.  177,  S.  S.  R.) 63-64 

Rules  of  Proce<lure  for  Medical  Advisory  Boards 66-69 

Special  and  limited  military  service  (sec.  188,  S.  S.  R.) 66 

(72) 

o 


